Client: Five states in the US (initially).
Objective: Administer Medicaid functions more efficiently and cost-effectively (serving 4.9 million Medicaid participants, more than 246 million claims per year, and more than $21 billion in benefit payments for the five states). Unisys was selected to design, implement, and manage a new claims processing solution for Medicaid and other state healthcare programs.
Unisys’ BTO value proposition for this client: (1) Domain expertise in healthcare administration and public-sector health and human service processes. (2) Expertise in systems integration. (3) Proprietary, holistic BTO methodology known as Unisys 3D-Visible Enterprise blueprinting. This four-layer architecture approach aligns strategy to execution and allows a client to consistently change with the dynamics of a market. The blueprinting builds a model for each layer of a business and then connects the individual models to fully align the business. The first layer digitally maps the business vision and operations model.
Results: Unisys designed the solution in a different way from existing massive Medicaid legacy systems. First, it conforms to Microsoft.Net to meet the cost-sensitivity needs of the public sector. More importantly, at its core is a rules-based engine – the business rules for administering the payments. US federal and state healthcare legislation – such as HIPAA – necessitate frequent extensive, complex programming changes to the rules engine. Such rules changes (i.e., benefits changes) normally require 20-40 full-time programmers onsite for the design implementation. These changes are very costly implementations. However, the variable logic driven by the robust Unisys rules engine enables end users to maintain numerous tables used in the administration of payments. The result is a 50% decrease in programming needs and ability for programming to take place remotely. Unisys now can support multiple states from the same centralized location and minimize the cost of ongoing changes. The transformed process enables clients to respond flexibly and faster in executing changes imposed by the government over the life of the contract. Furthermore, in an era when most states’ fiscal budgets are already stretched beyond limits, this solution dramatically decreases costs that can be better invested in innovation and business transformation of other state services to taxpayers.