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Elena Nicolella, Executive Directive of NESCSO, welcomed attendees to MESC 2021 with a message expressing the heightened importance of data and systems in the face of the pandemic. Setting the tone for the entire conference, she refocused attendees’ priorities and encouraged them to think of the larger implementations of what they are learning over the course of these four days.

Nicolella shared that MESC is “not about the technology… It is really about making Medicaid programs effective and successful” for those who truly need the benefits that these programs provide.

This sentiment was echoed by Amanda Kraft, Acting Assistant Secretary for MassHealth, speaking on behalf of the Commonwealth of Massachusetts. Kraft touched on the next phase initiatives of MassHealth, including incentivizing providers and Accountable Care Organizations (ACO) to combat health inequality, expanding access to both in and out-patient care, and increasing the availability of life-saving medications.

Flexibility and Creativity Guide the Future of Medicaid Technology

All future advancements hinge on innovative technology and expanding data access. “Over the last year and a half since COVID began, we have tried to be as nimble and creative as we possibly can to protect our members,” Kraft elaborated.

Themes of creativity and breaking the norm were reinforced by R. Michael Hendrix, Assistant Professor of Business Management at the Berklee College of Music and author of Two Beats Ahead: What Musical Minds Teach Us About Innovation. Advocating from breaking away from mainstream solutions, Hendrix emphasized that innovation and creativity breed progress in all industries, including the Medicaid space. This notion was further exemplified by performances by young musicians from Project STEP, a local organization dedicated to transforming the classical music space to better reflect diverse racial and ethnic communities. Project STEP brings in young and diverse talent to a field that honors tradition, an approach that echoes the need for both flexibility and innovation in the Medicaid space.

Balancing Risk and Innovation

Micky Tripathi, National Coordinator for Health Information Technology at the US Department of Health and Human Services, and John Halamka, president of the Mayo Clinic Platform, joined the session remotely to address industry trends and give insight from the private and public sector.

Both Tripathi and Halamka addressed the balancing act required by agencies to facilitate innovation. Medicaid Enterprise Systems (MES) should neither hamper innovation nor be at the forefront of technology due to the large associated risk. This leaves agencies in a difficult position where they must keep improving their technology to expand their benefit offerings but cannot engage in risky advancements due to how many individuals desperately rely on their services. Tripathi advised agencies to shift to a business-model approach that promotes flexibility and adaptation, slowly phasing out the brittle systems of the past.

Reaching out to different resources and minds to drive advancements allows agencies to focus on maintaining daily functions.

Halamka expressed that it is “completely fine for Medicaid to [be] good enough for daily operations while creating partnerships, joint ventures, and collaborations to take risks with the data.”

Risk Aversion and System Security

With the movement towards interconnected data and modularized systems, many leaders are concerned with what the future of security looks like. Halamka advocated for a layered approach to security to ensure multiple safeguards are in place. Additionally, Tripathi warned that innovative technology and the growing concern for cyber threats continue to transform the mindset of security protocols.

“Security is not a policy; it’s a process. You will never be done” Halamka ended.

Tripathi expanded on this by advising against investing all your resources into security to the determinant of advancement. “Let’s not pretend that by erecting higher and higher barriers we are archiving the goal,” he concluded.

Tips and Tricks for the Medicaid Modernization Journey

Everton Heron, the Information Systems Technology Manager for TennCare and David Whitham, Assistant CIO for Health and Eligibility for Massachusetts Medicaid, shared their experience achieving Medicaid modernization.

The key incentives for agency modernization include:

  1. Adapting to a shifting IT perspective
  2. Older systems cost more to maintain
  3. Enhanced analytics and flexibility
  4. A data driven and efficient approach

Ensure States are Ready Internally Before Beginning the Processes

While it is tempting to commence the procurement process to get a sense of the variety of solutions available, begin the process of system modernization by taking a catalog of internal resources. To get the most out of the available technology, states must first have a roadmap and framework of what they are looking to achieve.

States must be aware that modernization takes an all-hands-on-deck approach. Whitham advises that all states must determine if they “have the momentum inside [their] organization” to bring their vision to fruition. Interdepartmental communication is required to ensure that a functioning product that resolves the issues experienced by the state is produced. Keep businesses and technology aligned by educating all relevant staff.

Utilize Vendors to Outside Resources to Their Full Potential

Utilize partnership with old vendors and explore new connections. Outsourcing the technology required for modernization allows states to move outside their comfort zone by working with vendors.

Heron, the Tennessee Medicaid official, shared that the actual operations of the system proved to be a larger concern than standard requirements matrices. Ticketing and triaging concerns to ensure the systems continue to run smoothly was a joint effort from both the state and their vendors. Both panelists advised letting expert vendors share their knowledge to ensure a system is set to last the test of time.

Vendors are not the only resource states should lean on; CMS is a vital ally. Whitham advised, “as a state, if you’re not meeting with CMS monthly, you should be.”

Working with CMS to formulate a clear roadmap can help set states up for success from the state. Be upfront and transparent with overarching goals to ensure all parties are familiar with the state’s vision and are actively striving towards a specific goal.

Check back tomorrow for our recap of Day 3 at MESC 2021!