North Highland’s HHS team participated in the 15th annual 2024 State Health Information Technology (HIT) Connect Summit held in Baltimore, MD April 2-5. The annual conference brings together public and private sector thought leaders, technologists, solution providers, and policymakers to share ideas, lessons learned, and solutions to address some of healthcare’s most complex problems.
This year’s conference theme Harnessing Innovation & Accelerating HHS Ecosystem Transformation State covered key topics on the minds of state healthcare leaders. In this article, North Highland experts share insights, key takeaways, and trends from the conference.
Integrating Artificial Intelligence (AI) into HHS Service Delivery Solutions
AI is rapidly evolving in the public sector health and human services industry. States are exploring how to use AI to enhance the efficiency and effectiveness of healthcare delivery. We learned about several areas where AI is making significant strides in healthcare administration and delivery and some important considerations:
- Improved Customer Experience
Natural Language Processing (NLP) algorithms are being used to extract valuable insights from customer inquiries to streamline and even eliminate call trees and get customers what they need faster. Robotic Process Automation (RPA) is being used to create knowledge bases that provide key information to customers faster. The State of Arizona has used this approach and reduced its call center volume significantly. - Increased Operational Efficiency
AI-powered systems can streamline the Medicaid eligibility determination process by automating the verification of income, assets, and other eligibility criteria, reducing administrative burden and processing times for applicants. The State of Washington is using RPA (Robotic Process Automation) to improve productivity in its Eligibility Determination centers. Other states that are planning to use AI for their Program Integrity / FWA (Fraud, Waste, and Abuse) and Regulatory Compliance and Reporting use cases. - Concern about Data Bias
State leaders should implement mechanisms to identify and mitigate bias in AI algorithms when developing AI solutions. Data bias refers to the systematic errors in a data set that can result in inaccuracies or unfairness in AI algorithms' predictions or decisions. Mitigating data bias may involve conducting bias assessments, developing standards and guardrails, using diverse and inclusive training data, and employing algorithmic techniques.
Overall, we could see the excitement among the state agencies in how they see AI playing a pivotal role in driving innovation and improving outcomes in the public sector healthcare payer industry. As AI technologies continue to evolve, state agencies are poised to leverage these advancements to enhance operational efficiency, optimize resource allocation, and deliver more personalized and cost-effective care to their members. However, challenges related to data privacy, interoperability, and ethical considerations must be addressed to realize the full potential of AI in public sector healthcare.
Continued Focus on Interoperability
States and their federal partners are continuing to focus on interoperability as a critical element to ensure information is seamlessly exchanged and utilized across different systems, providers, and organizations. Federal regulations such as the 21st Century Cures Act and the Office of the National Coordinator for Health Information Technology (ONC) Interoperability Final Rule are driving interoperability initiatives and mandating the adoption of standards-based Application Programming Interfaces (APIs) for healthcare data exchange.
States have made progress in increasing data accessibility for patients and are now focusing on administration; exchanging data across agencies effectively to ensure data consistency and accuracy. State Medicaid programs are leveraging APIs to facilitate secure, real-time data exchange between Medicaid systems, providers, payers, and other stakeholders.
Interoperability is transforming the prior authorization process by enhancing efficiency, transparency, and collaboration between healthcare stakeholders. By leveraging interoperable solutions and standards, healthcare organizations can streamline prior authorization workflows, improve patient access to care, reduce provider abrasion, and reduce administrative costs. Leaders agree that the technology is there, but the challenge is that the policy and education is lagging
Optimizing Medicaid Transformation Delivery
Rick Zelznak, North Highland’s Health & Human Services Industry Lead, facilitated a thought-provoking roundtable discussion with states about trends in how states are using services such as Project Management (PM), Quality Assurance (QA), and Independent Verification and Validation (IV&V) to support their MES transformation efforts. Participants shared their perspectives and latest thinking around how different combinations of these services along with a “leave your logo at the door” mentality and strong governance have proven to be effective strategies for states at various stages of MES transformations.
Featured Authors
Ruth Klann
Nicolle Field