In August, North Highland had the pleasure of attending the 2023 MESC conference in Denver alongside some of the best and the brightest industry, state, and federal Medicaid leaders. The industry continues to evolve and focus on critical high-priority initiatives including advancing health equity, Public Health Emergency (PHE), MES transformation in a multi-modular world, and streamlined certification. Here we discuss some of the highlights, focusing on takeaways you can act on as you navigate these emerging and evolving trends.
Using Data Analytics to Advance Health Equity
CMS is working with states to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all the people served by Medicaid programs. This eliminates avoidable differences in health outcomes experienced by people who are disadvantaged or underserved and provides the care and support that our enrollees need to thrive. Beyond clinical data, state Medicaid agencies are incorporating data on social determinants of health, such as income, education level, and housing status. Data analytics methods are being applied to identify economically and socially marginalized groups and target program initiatives to eliminate these disparities. Value-based payment programs and service delivery models are being leveraged to implement identified changes to address health care disparities.
Lessons Learned from the PHE
The pandemic challenged service delivery in ways that were previously unimaginable. It created high demand for Medicaid services and required state agencies to come up with flexible, quickly scalable solutions just to keep up. Agencies can implement Agile technologies and methodologies and identify modern operational solutions to continue supporting a remote workforce and delivering for customers/beneficiaries in a virtual (or hybrid) environment. Innovative and interoperable solutions are taking center stage, helping states efficiently deliver critical customer coverage, expand access, and provide end-to-end care. States are resuming normal operations with CMS providing guidance. Many of the measures taken during the PHE are being considered to remain in place to maintain health equity, improve quality, and expand access to care. States are in varying places along the roadmap to unwind measures taken in response to the public health emergency and collaboration across stakeholders is essential to preserving continuity of coverage and care.
MES Transformation in a Modular World
As states continue the transition from legacy, monolithic Medicaid Management Information Systems to a more modernized and modular MES approach, they are reimagining their business models and strategies for procuring solutions. States are talking with each other to learn the best way to manage multiple vendors, embrace innovation, phase implementations, develop and execute strategic roadmaps, and partner with stakeholders to achieve program goals. There are innovative and alternative approaches to solicitation development and contract negotiation and management, such as the National Association of State Procurement Officials (NASPO) ValuePoint or the Invitation to Negotiate (ITN) procurement method. These procurement options can yield positive results for states in terms of time, resources, and cost savings. In addition, states are recognizing a great need to implement robust governance, organizational change management, and multi-vendor contract management solutions to support their MES transformation efforts.
Streamlined Modular Certification
CMS continues to focus on results and value, as demonstrated by implementation of Streamlined Modular Certification. More and more, states are using agile methodologies to help focus on delivering incremental business outcomes. CMS has transitioned its systems certification process to one that evaluates the “health of the program,” including how Medicaid information technology systems support desired business outcomes. This streamlined, outcomes-based approach is designed to reduce burden on states while ensuring that systems that receive federal financial participation are meeting the business needs of the state and of CMS. In CMS’s State of the State presentation, we learned that 59 systems were certified across the nation using the SMC process between 2021 and 2023 with many more in the queue for review. SMC ensures systems are assessed and determined to be either compliant or non-compliant with Federal requirements (CMS-required outcomes) and, when applicable, state requirements represented by state-specific outcomes.
Conclusion
MESC 2023 was a hub of intellectual and collaborative energy, and it was inspiring to see the progress that has been made in shaping the Medicaid enterprise for the modern world. The discussions were not just timely, but also forward-thinking. The future of the Medicaid enterprise lies in our collective ability to innovate, integrate, and place beneficiaries at the center of care. This conference was a testament to that vision, and the North Highland team looks forward to working with our clients to face the opportunities and challenges coming in the year ahead. Thank you, Denver, and see you next year!
