The Healthcare IT Connect Summit kicked off with pre-conference workshops enticing attendees to dig deep into the world of healthcare, Medicaid, and the implementation of innovative technology. Set in the bustling city of Baltimore, Maryland, the event welcomed emerging and established federal agencies and healthcare reform professionals. This 3-day conference intends to discuss Medicaid modernizations, MMIS re-procurement, payment reform, and the shift towards modularity.
In case you were not able to attend, here is our recap of key topics discussed:
Softheon Speaks: A Blueprint for States-Executing Medicaid Expansion and the ACA
Michael Sasko, VP Government Solutions, Softheon, Rosemarie Day, Founder & CEO, Day Health Strategies, and Amanda Schipp, Counsel of Kreig DeVault LLP explain the utilization of work requirements as a form of Medicaid expansion, 1115 Waiver approaches to managing the population, using normal premiums, and ensuring a close connection with ACA strategies. 25% of exchange populations are in the state-based world and the rest are on a federal platform. Looking back on 2019 plan year, open enrollment projections were dire because the elimination of the individual mandate penalty would have a bad impact on premiums and enrollment. Overall, enrollment numbers were only 2.4% down, SBMs were 1.6% down, non-SBMs were 3.8% down. SBMS have seen more growth than FFM on enrollment and have higher carrier participation. They pose the question, “Why have states been so successful?” The answer: they’re able to have flex with open enrollment periods, essentially make their own determination, unlike FFMs. Our speakers shed a spotlight on the Nevada Health Link, currently an SBM on the federal platform and is transitioning to a full SBM in 2020. Nevada Health Link would pay $5.1 million to operate its own marketplace compared to $13.2 million to use a federal platform.
The second part of Softheon Speaks explains the rise of 1115 Waivers and personal responsibility initiatives. A change in the CMS landscape proves positive health outcomes, promoted efficiencies, strategies to address health determinants, and quality of life. The conservative vehicle to expansion includes moving from welfare to a commercial model, introducing personal responsibility, and state-level innovation. On the contrary, states with denied waivers are facing limited eligibility for expansion population to 100% FPL, lifetime benefit limits, and drug screening conditions. Commonly approved 1115 Waiver policies include cost sharing, member accounts, member incentives, community engagement, and commercial market experience. Our speakers stress how there needs to be a strong link between employment and health. They believe this will result in improved overall health and addressing social determinants of health. Lastly, our panelists make a good point, “1115 Waivers don’t need to follow existing program work policies, though many states are.” They suggest several implementation considerations: waivers are focusing on broader issues not previously emphasized or required in administration of Medicaid benefit, operational experts must be involved in the development of policy early on with execution of these waiver programs.
Blockchain and Medicaid
Blockchain is a continuously growing list of records, called blocks, which are linked and secured using cryptography. Tom Kapusta, Senior Consultant at Public Consulting Group and Chris Smith, Clinical Data Program Manager at Mississippi Division of Medicaid opened up the discussion explaining the basics of blockchain and eluding to solving the interoperability equation. Each block within blockchain typically contains a cryptographic hash of the previous block, a timestamp and transaction data. By design, a blockchain is inherently resistant to modification of the data. Smith and Kapusta explain how healthcare and blockchain can work together for new member onboarding, providing consumer empowerment, ownership, audit trail for changes, secure and permission-based access to profiles. In other words, eligibility and enrollment can be streamlined. If Agency A and B need credentials for an individual, blockchain can share that credentialing info to avoid duplication of effort.
Looking at the landscape of implementation from a national government perspective, Estonia implemented blockchain technology for identity management and documentation for citizens. Finally, our speakers dive into how blockchain can be used at a Medicaid agency. For example, Mississippi has 680,000 active beneficiaries. The program goals consist of using aggregated clinical data from provider EHRs and clinical systems. Secondly, sharing aggregated data with providers to support beneficiaries at the point of care. Utilizing clinical data (internally) within the agency can improve quality and lower costs for Medicaid beneficiaries.
Addressing Social Determinants of Health: Waivers, Medicaid, and Health Plans
Kelly Crosbie, Deputy Director, Quality and Population Health, NC Department of Health and Human Services opened up the session discussing her state’s 1115 waiver, Healthy Opportunities Pilot. Their new managed care system will collect data and address the ignored health needs of her residents. Some domains she plans to focus on are food, transportation, and requiring issuers to answer 8 standardized questions. With this data, they’ll look across all entities for people who qualify for other HHS systems like TANF. Ellen Harrison, Vice President, Market Strategy and Consulting, HMS interjects her concern for risk analytics, population management, risk intelligence, and care management tools. She believes claims data cannot provide information on social determinants of health, and HMS gets this information from other data. Harrison explained SDoH change week-to-week and to stay up-to-date, it’s imperative to reach out to patients verbally.
Moving along to Ann Oshel, SVP Community Relations, Alliance Behavioral Healthcare explained how opportunities for having SDoH part of the clinical engagement is a game changer. Oshel said “Writing a prescription for affordable housing and turning it into an actual voucher—that’s what Alliance is helping to do.” Lastly, Shane Owens, Health IT Design Lead Socio-Technical Systems Division, Georgia Tech Research Institute closes the plenary with his efforts working on the TAF grant. He believes it’s important to understand which data really matters for health, “…to demonstrate a personal health record and develop an electronic service and report data standard.” He agreed with Harrison on her point of data changing over time, you must collect data in a way that stays fresh and trustworthy.
Empowering Citizens via Sustainable Health Data Ecosystems
State and local health IT leaders acknowledge the challenges of delivering customer-focused results while battling the pressure to optimize resources. Our keynote speakers, Susan Dentzer, Appointed Visiting Fellow, Duke-Margolis Center for Health Policy and Taha Kass-Hout, MD, MS, Senior Leader Health Care and Artificial Intelligence, Amazon explore the struggles of having access to healthcare if you are low-income. Kass-Hout tells the crowd his story from the CDC in 2009, kids were dying from H1N1 and the public health system were sustainable but couldn’t afford to pay staff. They partnered with hospitals to work ahead of pandemics. He noted HIT vendors have transformed the way we consume information and derive insights.
Referring back to his current position at Amazon, he began, “Amazon, from the time you find the item to the time you put it in your carts, it doesn’t take more than 30 seconds of your day, including tracking. Doesn’t even require login.” He encourages the audience to start thinking of patients as people and customers. He believes it’s important to find cost transparency and tailoring medicine to income. His final point brings us to artificial intelligence (AI) and machine learning, how can they help? He asked, “How do you remove the heavy learning, so everyone can use them?” Kass-Hout reveals Amazon’s sage maker web system can be used to predict whether claims will be denied with 98% accuracy. He closed his session by expressing the future of health care as “Finding right treatment for right individual at the right time to keep them engaged in a 365-day model of care.”
For more information on Verify, visit booth #14 or schedule a demo with Michael Sasko at msasko@softheon.com
Check back tomorrow for our recap of Day 3 at HITC Summit 2019!
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