Reframing Medicaid Platforms

About the Client

The client is a US healthcare technology provider that builds and runs Medicaid management and healthcare analytics platforms for public-sector agencies. It supports programs under constant pressure: strict compliance requirements, high transaction volumes, and expectations for faster service delivery amid tighter budgets.

Its portfolio spans modular Medicaid enterprise capabilities, including provider-focused functions, third-party liability recovery, and analytics-driven program integrity. That mix puts the company at the intersection of operations, data, and policy, where platform reliability and data trust directly shape outcomes for agencies and the communities they serve.

Business Challenges

The client’s Medicaid management and healthcare analytics platforms had to keep pace with multi-state growth, strict compliance demands, and rising expectations for faster onboarding and better program oversight. But legacy platforms and manual processes made that hard to scale without adding cost and operational risk.

Key Challenges Included:

• Legacy provider management could not scale efficiently: The existing platform struggled with agility and high operational overhead as adoption grew.
• Provider verification remained slow and manual: Manual workflows delayed enrollment, which slowed provider onboarding and created downstream access-to-care delays.
• Claims and health data stayed fragmented: Disconnected data limited analytics, which constrained value-based care initiatives and broader insight generation.
• Third-party liability recovery required intensive manual work: Identifying recovery opportunities and orchestrating workflows took too much effort and time.
• The on-premises footprint drove cost and risk: High infrastructure costs and operational exposure came with maintaining a large on-premises environment.
• Security and compliance requirements stayed non-negotiable: The platform had to secure Protected Health Information (PHI) and Medicaid data while meeting stringent security standards.

To move forward, the client needed a scalable, secure cloud-native architecture, automated provider verification, unified analytics for claims and health data, systematic liability recovery, and stronger DevSecOps resilience.

LTM’s Solution

With LTM as its Business Creativity partner, the client modernized its Medicaid management and health analytics suite by standardizing products on a shared AWS foundation.

We focused on two goals: removing the limits of a large on-premises footprint and creating modular platforms that states and payers can onboard faster without reworking core infrastructure each time.

• SaaS provider management built to scale across states and payers: LTM re-architected the legacy provider management platform into a microservices-based, SaaS-style solution on AWS.
• We migrated over 200 on-premises virtual machines to Amazon Elastic Compute Cloud (EC2), orchestrated containerized microservices with Kubernetes, and implemented secure Virtual Private Cloud (VPC) and Virtual Private Network (VPN) patterns to support expansion without repeated redesign.
• Provider verification as a reusable, automated service: The team designed a configuration-driven verification-as-a-service platform that automates ingestion, standardization, and verification of provider data from diverse sources. Configurable rule sets validate enrollment data and convert manual workflows into automated services that teams can reuse across programs.
• Unified health data analytics for governed, HIPAA-ready insight: LTM built a scalable data lake that harmonizes claims and clinical data from multiple states in a Health Insurance Portability and Accountability Act (HIPAA)-compliant environment.
• Machine learning models support analytics for value-based care, fraud detection, and population health, while self-service dashboards provide governed access for agencies, payers, and researchers.
  
• Third-party liability recovery to strengthen payment integrity: The team then developed a solution that correlates claims, eligibility, and policy data to flag candidate claims for investigation and orchestrate recovery workflows end to end.
  
• Shared cloud, security, and DevSecOps foundations across products: Across platforms, LTM implemented automated CI/CD pipelines, security scanning, and centralized monitoring to improve operational resilience and support compliance for PHI and Medicaid data.

Business Benefits

By standardizing its product suite on AWS, the client improved cost control, release reliability, and program insight across Medicaid operations and analytics:

1. 30% lower infrastructure costs for provider management: Reduced platform run costs after modernization.
2. 32% cloud cost savings for the analytics platform: Lowered analytics run costs while scaling data ingestion and processing.
3. 50% less downtime during releases: Improved release stability and business continuity.
4. 20% higher deployment velocity: Shipped changes faster with stronger DevSecOps foundations.
5. Provider verification timelines reduced from weeks to days: Accelerated onboarding and improved access to care.
6. Analytics at scale across states and sources: Processed 300M+ claims, generated 100,000+ high-value alerts, and integrated 1,000+ data sources. 

Conclusion

By partnering with LTM and standardizing its product suite on AWS, the client turned isolated legacy systems into a cohesive, cloud-native Medicaid management and analytics ecosystem.

The modernized platforms support agencies, health systems, and payers by enabling faster modernization, improved provider experiences, stronger payment integrity controls, and actionable insights at scale.

With a secure, extensible AWS foundation, the client is positioned to expand into new states and layer advanced analytics and AI capabilities across its healthcare product portfolio.