With more than 74.6 million enrollees, Medicaid is one of the largest healthcare programs in the U.S. Yet, outdated systems pose challenges to meeting the growing demands of Medicaid populations. Today, Medicaid accounts for one-sixth of all healthcare spending and half of long-term care spending, making it a large share of state budgets.¹ This significant financial commitment underscores the critical need for efficient, modernized systems.
Recognizing the limitations of its older infrastructure, the Utah Department of Health and Human Services decided to overhaul its Medicaid system completely. This effort, recently discussed at the 2024 Medicaid Enterprise Systems Conference (MESC), provided valuable insights into how Utah’s successful implementation could serve as a model for other states facing similar challenges.
Ensuring Success Through Rigorous Testing & Certification
One key step in Utah’s system overhaul was its rigorous approach to testing and quality assurance. The state implemented a multi-phase testing strategy – including parallel testing and user acceptance testing (UAT) – to ensure every aspect of the new system was thoroughly vetted before going live.
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Utah’s testing process involved around 30,000 test scenarios. This thoroughness was essential to identifying and addressing potential issues early, minimizing disruptions during the transition.
Utah executed a three-month soft launch period before the official go-live date to ensure a seamless transition. This phase involved extra validation, comparing the new system against the legacy system to verify all functions. This careful approach allowed Utah to identify and resolve discrepancies, ensuring a smooth rollout.
Another key component of Utah’s success was the early adoption of CMS certification processes. By engaging with these processes early, Utah maintained alignment with federal requirements, ensuring the system met all necessary standards before launch. This proactive approach helped avoid delays and positioned Utah as a leader in Medicaid system modernization.
The introduction of innovative testing tools and methodologies through Acentra Health played a crucial role in this process. Utah streamlined project management and prevented bottlenecks by using a collaboration tool to manage risks, document issues, and log decisions, paving the way for a smoother, more efficient launch.
Organizational Change Management: The Human Factor
Transitioning to a new system isn’t just about technology—it’s about people. Beyond the technical aspects, Utah’s success hinged on effective organizational change management (OCM).
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Organizations with excellent change management practices are six times more likely to meet or exceed their project objectives.
Utah’s OCM strategy included establishing Change Champion workgroups, where individuals from different areas could observe and influence the change process. This helped identify potential resistance early and ensured seamless integration of changes across the board.
Regular communication and transparency were also key. Utah’s team held daily check-ins and workgroup sessions to keep everyone informed and engaged. This consistent communication fostered a strong sense of team unity, vital for navigating the complexities of such a large-scale implementation.
The OCM strategy also included cross-training efforts to ensure flexibility and coverage across the team, address potential bottlenecks, and ensure effective support during the transition. With these comprehensive OCM efforts, Utah effectively managed the human side of change, paving the way for an efficient transition to the new Medicaid system.
The process wasn’t without its speed bumps, however. Early challenges with external vendors led the state to adopt an agency-managed OCM plan. This approach continued even after they established a new partnership with their vendor-of-choice Acentra Health as it allowed them to ensure their project needs and deliverables aligned with the agency’s business objectives.
Creating a Strong Foundation: Strategic Preparation & Collaborative Partnerships
One of the cornerstones of Utah’s success was its strong partnership with Acentra Health. As Utah expanded Medicaid, the need for a comprehensive, scalable system became evident. The state chose a phased approach, gradually transitioning from the old system to the new one, which was fully launched in April 2023.
Utah’s strategy centered around careful planning and stakeholder engagement. A critical factor was the importance of Phase 0, where the team transitioned from the “as is” state to the “to be” state by breaking out requirements. This foundational phase created a clear roadmap and set the stage for the project.
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Utah learned from other states’ experiences – this proactive approach allowed the state to refine its processes, avoid common pitfalls, and set realistic expectations from the outset.
Another key to Utah’s success was its proactive approach to learning from other states. By studying other Medicaid programs, Utah refined its processes and created detailed expectations documents, ensuring all parties clearly understood project goals. Additionally, Utah ensured mutual understanding among all stakeholders before engaging vendors, which was crucial for maintaining coherence and coordination throughout the project, ultimately leading to a successful implementation.
Looking Ahead: Lessons and Insights for Medicaid Modernization
Utah’s Medicaid system overhaul, marked by meticulous planning, rigorous testing, effective change management, and strong partnerships, offers valuable insights for states embarking on similar modernization journeys. The collaboration between Utah and Acentra Health highlights best practices that can help shape the future of Medicaid systems nationwide.
As state governments face increasing demand for digital citizen services, legacy modernization has become even more critical. This priority has consistently ranked on the State CIO Top 10 list, reflecting the urgent need to update outdated systems that can no longer meet the demands of the 21st century.² Utah’s experience underscores the importance of addressing these legacy challenges to build a more responsive and resilient healthcare system.
Sources: 1. https://www.kff.org/report-section/50-state-medicaid-budget-survey-fy-2023-2024-executive-summary/; 2. https://www.nascio.org/resource-center/2023-state-cio-survey/#legacy