Case Study: Chapter 14

2. Evaluate the risks of the Medicaid claims processing system project and key risk factors.
The main risk of such a huge change to a system like this is that if something goes wrong, people who need money for medical expenses cannot receive it. This should make a big change like this a very carefully done process. Because people's well being could be affected this becomes a very risky project. Other risks of the project include the fact that the system is so widely used and with a limited staff a backlog of issues would be disasterous. In addition the possibility of failure could be very costly to the state. In this case it cost the state over $30 million to try to right the ship.

3. Classify and describe the problems the Maine Department of Human Services faced in implementing its new Medicaid claims processing system. What management, organization, and technology factors caused these problems?
-Only two firms submitted bids for the job
-Provider information was considered incomplete after the transfer
-Program was based on J2EE which was not compatable with legacy systems
-Unusually high suspension of claims
-Too high call volume for 13 people on staff.

The main reasons for these problems were as follows:
Management: With only two bids, the project manager should have performed more investigation. It turned out that CNSI had never built a Medicaid system before. So this was a first time thing for them which makes it understandable that things did not turned out as planned.
Organization: A limited staff of 13 people for 7,000 providers would be one major organizational issue. With problems growing and a limited staff to adress problems the creation of a backlog of issues is inevitable.
Technology: The incompatibility with legacy systems created major issues. Because the incompleteness of provider information, different code numbers, and lack of training on new systems created a very sticky situation.

5. If you were in charge of managing this project, what else would you have done differently to increase the chances for success?
The first thing I would have done differently would have been to make a better assessment of the bidders for the job of establishing a new system. It would be worrying that only two firms would respond with a bid. You would think with such a big project you would have many people vying for an opportunity to claim the project. In addition, it would be unsettling that the one of the bidders was half the price of the other. This would have justified an investigation into what would be done differently and why the prices differed so greatly. At that point, had I chosen CNSI, I would definitely abide by their recommendations. When they recommend that "all providers re-enroll" I would have took their word for it and done just that instead of transferring the accounts to the new system. Another thing I would have done would be to run thorough tests on the system to ensure that it would be functioning properly. This would have brought to my attention the increase in suspended claims and would have allowed time to fix the issue before it got too far out of hand.