Provider Solution Implementation: Six Common Pitfalls (and How to Avoid Them)

State Medicaid agencies increasingly recognize that provider system modernization is more than a technology upgrade. It’s also a strategic investment in network adequacy and member access to care.

When these systems make it easy to join and participate in a Medicaid network, providers benefit from streamlined processes — and Medicaid members gain improved access through enhanced provider recruitment and retention.

Yet even with careful planning and significant investment, many provider system implementations fall short of their goals — leading to frustration for agencies, providers, and, ultimately, the people they serve.

With more states exploring replacement or modernization of legacy provider systems, how can they increase their odds of success? Having worked with numerous state agencies on provider systems, Gainwell has identified six common pitfalls — along with strategies for avoiding them.

Pitfall #1: Underestimating time and resource requirements

One of the most frequent missteps is underestimating the resources required to meet what is often an aggressive timeline. Without proper resource commitment — including making knowledgeable and empowered employees available for regular engagement — project schedules become impossible to maintain.

We’ve also observed similar challenges when it comes to data conversion. While agencies may expect the vendor to handle this work independently, the reality is more complex. If the provided data is poor in quality, the vendor will need to complete multiple iterations to achieve clean data conversion. But when data conversion falls behind schedule, it leads to delays in system integration testing, which then causes the state to miss user acceptance testing timelines, too.

The bottom line? Allocating insufficient resources will put any initiative behind the proverbial eight ball, cascading into project-wide delays that can be difficult to overcome.

Pitfall #2: Underinvesting in change management

Minimizing investment in internal and external change management is one of the most common implementation missteps. By assuming that it’ll be easy to communicate with state workers and network providers, agencies may not make the proper investment in organizational change support.

The consequences can be dire — including systems being rejected when users can’t (or won’t) adapt to new processes. Without the right messaging and leadership support, implementations fail, defeating modernization goals and resulting in significant amounts of wasted money and effort.

Notably, change management isn’t just about training; it’s about preparing people psychologically and operationally for new ways of working. Overlook this critical component, and even the most technically sound system can fail to gain adoption.

Pitfall #3: Being unintentional about decision-making authority

Making decisions by committee creates momentum-killing delays, while having the wrong decision-makers in critical meetings wastes valuable time. From the start of the project, it’s critical to appoint and empower clear decision-makers. In other words, identify and articulate who has the authority to make decisions across security and functional areas — and ensure those people are available to support critical meetings.

Requirement validation sessions provide a prime example of this principle in action. If key decision-makers are absent, the sessions are rendered futile. The best-case scenario? The meetings must be rescheduled. The worst case? Completed work must be redone with the proper stakeholders present.

Pitfall #4: Choosing a vendor that doesn’t know the terms and conditions

Contracts for provider system implementations are typically complex, prompting detailed questions from Medicaid agency workers throughout the process. If a vendor’s staff lack contract knowledge and requirements mastery, they may struggle to answer such questions quickly and accurately.

Vendor teams need to be well prepared with contract information and requirement details — with a clear understanding of how requirements are met before client meetings begin. If a vendor can’t answer basic questions, such as How many SLAs are in our contract? or What specifically does our agreement say about data security requirements?, it erodes trust and creates early credibility gaps that can be difficult to close.

Pitfall #5: Getting stuck in a cycle of reactive issue resolution

There will always be urgent issues — no matter how well prepared the vendor and agency teams may be. But firefighting shouldn’t become the focus. When teams spend all their time responding to immediate crises, they lose sight of the bigger picture and fall behind on proactive planning activities. To stay on track, teams need to have sufficient capacity for proactive work, including risk identification, process improvement, and strategic planning.

Pitfall #6: Falling prey to siloed communication

Provider system implementations require cross-functional involvement from multiple teams, departments, and often external stakeholders. But if these teams stay within their silos, they will cause ongoing confusion and create unnecessary rework.

When realignment becomes a constant reality, people aren’t sure which direction to go. In many case, they’ll just stand still, waiting for clarity that may never come. This paralysis can bring progress to a halt — and create frustration across all stakeholders.

Six strategies for success

If those are among the most common pitfalls, what are the strategies for avoiding them? The best way to start is by choosing the right vendors — organizations that bring extensive experience implementing modern provider solutions and offer demonstrated strengths in leading and coordinating across six critical areas.

1. Comprehensive change management

Look for vendors with proven experience engaging internal and external stakeholders, whether directly or in support of internal staff. Successful change management requires commitment and clear messaging upfront to bring change forward, along with leadership alignment and consistent messaging. The most effective vendors also know that change management is an ongoing process that requires attention, resources, and expertise throughout the project lifecycle.

2. Thorough staff preparation

Successful initiatives require vendor teams to get aligned on objectives, requirements, and SLAs from day one. This includes creating a common language framework for all stakeholders and securing contract knowledge mastery before client meetings begin.

Vendor staff must know contract details, requirements, and how requirements are met. They should be able to provide direct explanations of what the product does and how it meets specific requirements rather than learning such details on the job.

3. Proactive issue resolution processes

The best vendors establish teams and protocols recognize they’ll face unexpected challenges no matter how well prepared they are. The key is to have mechanisms to respond more efficiently when issues arise. By building capacity for both reactive problem-solving and proactive risk management, the team can handle urgent issues without losing momentum on planned activities.

4. Decision-making clarity

Effective vendors work with agencies to identify and empower the right decision-makers upfront. Teams can then move forward knowing that the choices they’re making have proper backing and won’t need to be revisited later.

5. Regular communication cadences

From the very beginning of a project, successful vendors establish communication standards among clients, vendors, and teams. That includes establishing and maintaining alignment among interdependent teams by holding weekly workstream lead calls where every team provides status updates. Effective communication also means aligning communications to SLAs and requirements. Strive to create a common language that all stakeholders can understand and use consistently.

6. Collaborative spirit

Choose vendors willing to partner with the agency and with each other. After all, there’s no room for egos or competition in a successful implementation. Seek vendors with extensive experience with similar projects, as they will be better positioned to anticipate and address emerging challenges.

The stakes are high

Failed provider system implementations squander money and time and erode provider trust. When providers become frustrated with system problems, they may choose to limit their Medicaid participation or leave the network entirely — potentially reducing members’ access to care. By avoiding classic pitfalls and focusing on success strategies, state agencies can increase their odds of achieving implementations that truly serve their providers, members, and broader healthcare goals. Just as important, look for a partner with the experience to anticipate challenges and have solutions ready — along with a collaborative spirit to bring together multiple stakeholders and systems.