Chapter 14 Case Study

2. Evaluate the risks of the Medicaid claims processing system project and key risk factors.

The medical claims processing project in Maine had a high level of risk in all three of the major risk catagories.
Project size- This project was huge in the scope and dimension and programming effort. The many records processed each day and the volume of traffic is huge, thus a perfect system is required.
Project structure- This project will have significant structure associated with it. There must be multiple reports and formats with a huge number of transactions to process and document accurately as well as a logic process that is consistent with the current system.
Experience with Technology – Designing a system such as this is a huge undertaking. Not only does the programmer need to understand the database, he also needs to understand the Medicaid payment system inside and out in order to design a system from the ground up. Any less knowledge will only increase the risk of errors in the final product.

4. Describe the steps you would have taken to control the risk in the IT modernization project.

Personally, I would have made the transition in two phases. In phase one I would have followed the lead of other states and built a front end onto the existing database system. This would minimize any clerical errors in the behind the scenes processing and allow time for full development and testing of the new system. Obviously this will typically require a larger budget, however, the new system would not have to be funded all at one time nor would it have had the rushed timeframe to make it all perfect on such a short deadline.

5. If you were in charge of managing this project, what else would you have done differently to increase chances for success?

For me this is simple. I would have hired a firm with experience in writing for this type of process. I would have required more testing prior to implementation, both in a controlled trial environment and then on a limited basis with a select few providers in order to assure to the maximum extent possible, a trouble free system was deployed. I would have offered significant training to the office staffs on the changes and how to best work with the new system and then on a temporary basis hired additional staffing to man the trouble desk to deal with the changeover.