The Healthcare IT Connect Summit rang in day 3 discussing agency data sharing and collaboration, the West Virginia Asset Verification System (AVS) journey, followed by an update from the National Coordinator for Health IT. Attendees are addressing state challenges, promoting interoperability, while keeping the overarching theme of Medicaid modernization in mind.
In case you were not able to attend, here is our recap of key topics discussed:
Softheon Speaks: West Virginia AVS Journey
CMS mandate known as Section 1940, to the Social Security Act (SSA) requires all states to implement an electronic system for verifying the assets of aged, blind, or disabled applicants for, and members of, Medicaid. Robert Miller, GM Government Cloud Solutions, Softheon and Jon Cain, Interim CIO, OIS, WV DHRR revealed how they responded to new legislation in West Virginia which required verification’s of estimated 350,000 SNAP recipients NLT 1 January 2019. West Virginia executed phased approach: first a portal experience (meeting CMS Mandate) to engage the states 800+ enrollment specialists and second integrated solution into the West Virginia eligibility system known as eRAPIDS. This 2-phase approach allows for training, testing, and user-influenced design prior to integration within a newly deployed MMIS system.
Miller explained, most states are implementing electronic verification and the challenge is having not enough time to look at undisclosed assets. Most states are verifying checking, savings accounts, pay stubs, and insurance policies. He shed light on the Washington Office of Inspector General (OIG) study displaying abundant Medicaid fraud. They identified a population of people who had been approved for Medicaid, of which 58% of cases had transferred assets. “It’s a burden to do manual searching without electronic verification. You have to sort through various documents and visit tons of websites.” Miller tells attendees. CMS has mandated electronic verification for a long time, but it hasn’t been enforced. States like Illinois, Mississippi, and Oklahoma took it upon themselves to create their own legislation to enforce electronic verification. Softheon’s Verify workflow process possesses 3 entry points: from batch, from portal, or from API. It creates the asset transaction and runs the business rules with a return of the summary in portal. All of this data gets aggregated into Softheon’s product, Foundry, then generates an asset verification report and eligibility data. For more information on Verify, download our infographic.
Moving Forward in Cross-Agency Data Sharing
States have exposed their challenges with implementing modular solutions that comply with federal regulations and state business objectives. Being able to compile a strong plan to identify risks and issues early on can streamline business objectives for the user experience. Elizabeth Reed, Program Manager, General Dynamics Information Technology (GDIT) and Tom Silvious, Director, General Dynamics Information Technology discussed their approach to supporting states in this time of change while promoting an increase in interoperability and data sharing. In Reed’s and Silvious’s efforts to promote interoperability, they’ve worked with various vendors to develop PoC that support a variety of business objectives: Section 1115 Waivers (opioid addiction/care management), value-based purchasing, and myhealthEData. They expressed their embrace of fast healthcare interoperability resources (FHIR) standards in API development. Our speakers began outlining initiatives that can be supported using FHIR APIs, for example, CMS proposed rules, 1115 Waivers, value-based care, modularity, and care management.
The session finished off with a detailed explanation of lessons learned through Reed’s and Silvious’s experiences at GDIT. It’s vital to create business service definitions that align business scope boundaries. Leveraging reference implementations like Blue Button 2.0 or sandbox provide useful patterns for the technical aspects, contributing to reduced implementation time. Next, building test harnesses helps work through differing interpretations of the implementation guide. Lastly, coordinating release management helps to plan ahead for industry adoption of new versions and mindful backend compatibility. Our speakers’ final message emphasized the importance of simplifying data exchange agreements.
Closing Keynote: Update from the National Coordinator for Health IT
Dr. Don Rucker, National Coordinator for Health IT provided insight into the recent interoperability rule. He said, “Interoperability is how you get all the programs you’re working on to talk to each other.” In 2016, congress unanimously passed 21st Century Cures Act. Historically, we were forced on electronic medical records. Rucker explained the ONC is a staff agency within HHS and they work closely with CMS. The big provisions to change the game include information blocking, no charge to receive your own health data, and having standardized APIs. To further his point, Rucker alleged “The tech that allows you to access your health data is API (application programming interface)—the door that allows data to move. In the rule, APIs are driving the great stuff on your smart phone.”
Rucker believes APIs have transformed people’s lives. He told attendees, “Right now these APIs have been about the individual. But if we want to do public health work, we have to look at a population. Not just for public health, but for the people who buy our health care to see what we’re getting.” He posed the question to his audience, what do we need to do as a country to get healthcare back to us? The ONC believes this rule will be transformative and generate new business models. Rucker closed his keynote with, “We can change American health care not just in the medical office but in the community.”
Mike Sasko , VP Government Solutions, Softheon, sat down with Healthcare IT Connect’s Rob Waters to discuss implementation of AVS across HHS agencies in a modular environment. Full interview here.
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