The Medicaid Enterprise Systems Community (MESC) is a national conference and community for state, federal, and private sector individuals to exchange ideas related to Medicaid systems and heath policy affected by those systems. In this blog series, two North Highland experts leverage insights gathered at this year’s event to discuss key takeaways and trends you’ll want to know about.
In August, I had the pleasure of attending the 2021 MESC conference in Boston alongside some of the best and the brightest industry, state, and federal Medicaid leaders. A great deal has changed in the industry since the last conference in 2019. Many, if not all, of these changes were accelerated by the COVID-19 pandemic:
- Policies have changed to meet the needs of a growing Medicaid population.
- States have made progress with Medicaid Enterprise Systems (MES) transformation and modularity, innovated procurement practices, and evolved solutions to meet interoperability standards.
- States are focused on achieving Outcomes-Based Certification (OBC).
Off the back of the event, I’m sharing some of the highlights, focusing on takeaways you can act on as you navigate these emerging and evolving trends spanning a variety of critical topics:
- COVID-19 called for reimagined solutions and ways of working.
The pandemic has challenged service delivery in ways that are 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.
- MES transformation requires innovative and flexible procurement solutions.
As states embark on 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. As we discussed in a recent white paper, 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.
- Interoperability and OBC continue to be high priorities for states.
On March 9, 2020, Centers for Medicare & Medicaid Services (CMS) released a final rule (CMS-9115-F) addressing interoperability and patient access to health data, with the goal of empowering patients to make informed decisions about their health with improved access to data and higher quality data. This rule has impacted how states, managed care entities, electronic health record vendors, and providers operate. Conference participants were particularly eager to discuss the interoperability and OBC requirements from the federal agency.
Based on dialogue at the conference, it’s clear that data management and data governance will play a key role in facilitating OBC and advancing states’ progress. Additionally, cross-program data ecosystems with enhanced analytics and flexible data-driven outcomes are likely to improve healthcare outcomes and increase access to critical patient care.
- Customer experience is more important than ever.
People-centric design will be a key focus for states in the years ahead as they embark on transformation journeys that put the customer first. With a clear vision and a customer-oriented transformation strategy, the public sector can capitalize on a significant opportunity to transform Medicaid customer experience (CX). We discussed this concept in a recent blog, where we outlined the benefits of leveraging a centralized contact and operation center to overcome fragmented Medicaid operations and communications, transform technology, and ultimately enhance CX.
About the Author
Ruth Klann