The Year of Metrics, Artificial Intelligence, and Inter-State Collaboration
North Highland attended the 2024 MESC conference in Louisville 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 a focus on the advantages of inter-state and federal partnerships, the benefits and applications of Artificial Intelligence, and challenges managing multi-vendor MES implementations. Here we discuss some of the highlights and takeaways you can act on as you navigate these emerging and evolving trends.
MES Module Implementation Challenges
A persistent issue that received much attention at the conference is the struggle that many states face in getting key Medicaid modernization projects successfully to the finish line. These strategic projects face a variety of obstacles, including:
- Effectively monitoring and managing major investments: Traditional tools such as contracted Project Management Offices (PMO), Quality Assurance (QA), Independent Verification & Validation (IV&V) do not seem to be assuring the outcomes that the states seek. IT and Medicaid organizations are working to determine projects continue to fail and these traditional approaches to oversight are not always working.
- Procurement documents guiding these projects are under scrutiny: states have included many different mechanisms in attempt to hold vendors accountable. Rigorous key performance indicators (KPIs) backed up with fines, liquidated damages, and other financial penalties also do not seem to have the power to ensure states, and their partner, Centers for Medicare & Medicaid Services (CMS), are seeking new ways to hold vendors to the promises made in their proposals.
North Highland has led the way helping states with multi-vendor, multi-module enterprise projects. At North Highland, we are committed to partnering with our state customers to ensure that their projects succeed.
The Staying Power of Artificial Intelligence (AI)
There is no question that AI is changing the way people work. The potential applications within Medicaid vary from automating manual or mundane tasks to analyzing data, identifying patterns, predicting outcomes, interacting with customers, and generating content.
Imagine employing a solution that identifies a potential member's need and recommends a service based on specific social determinants of health (SDoH) data. The impact could be transformative for the beneficiary.
The most common question asked by Health and Human Services agencies is, “where do we start?” The best place to start is with a singular focus on the members and their care with a goal of minimizing the risk of AI technology while maximizing the benefits of health outcomes.
Implementing a transparent, ethical and responsible AI framework and process includes:
- Zooming Out: Look at the big picture and plan for AI’s impact on data, people, processes, and technology.
- Connecting the Dots: Create the context for the data, people, process, and technology that powers new AI-enabled business and operating models.
- Zooming In: Craft an intentional roadmap that leverages a data-driven approach with clear guidelines, policies, and oversight mechanisms to mitigate risks associated with AI adoption.
- Executing: Execute according to a strategy-aligned prioritization to embed AI within the organization and drive continuous improvement with proper governance, training, and resources provided by an AI Center of Excellence (COE).
By taking the time to follow these steps, executives can accelerate the identification of high-impact AI initiatives that align with the organization’s strategic goals to harness the full potential of AI and drive significant and sustainable value creation.
Refocusing on Partnerships
One of the most critical themes that emerged was the importance of inter-state collaboration, where states are increasingly sharing technology platforms, lessons learned, and best practices to streamline operations and reduce costs. Cooperative purchasing agreements, like those facilitated by the National Association of State Procurement Officials (NASPO), can be key enabler of these partnerships.
With NASPO contracts, states can leverage better terms, access a broader range of technologies, and implement solutions faster, all while reducing procurement burdens.
- Technology Sharing: States are collaborating to develop and share modular technology solutions that can be adapted to meet the unique needs of each Medicaid program, fostering a more flexible and cost-effective approach to system modernization.
- Lessons Learned: Cross-state dialogues are becoming more structured, with states openly sharing both successes and challenges in implementing new systems, allowing others to avoid pitfalls and accelerate their own projects.
- Cooperative Purchasing: NASPO contracts can empower states to leverage collective bargaining power, ensuring access to high-quality vendors and solutions at competitive prices, thereby maximizing the impact of limited resources.
State-to-State partnerships and cooperative purchasing aren’t the only places for collaboration. The importance of engaging with federal partners, particularly the CMS, as early and often as possible, was underscored. Early engagement with CMS allows states to align their initiatives with federal guidelines, access available funding, and navigate the complex regulatory landscape more effectively. This proactive approach not only helps ensure compliance but also opens opportunities for states to influence federal policy and drive national-level innovation in Medicaid systems.
By fostering strong partnerships at both the state and federal levels, states can better position themselves to meet the evolving needs of their Medicaid programs and deliver improved outcomes for their beneficiaries.
