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Day 3 of the Medicaid Enterprises Systems Conference (MESC) featured multiple sessions that dived deeper into the logistics of systems overhauls by vendors and state representatives. The diversity and abundance of sessions depicting the nuances of system advancements prove that states have a variety of options at their disposal.

Preventing Fraud and Abuse with Enhanced Eligibility Verification (EV)

John P. Crouse, a Vice President at Maximus, spoke about the benefits of implementing an Enhanced Eligibility Verification (EV) solution, a popular topic that other sessions throughout the conference focused on or alluded to. The popularity of using federal, state, and third-party data to determine eligibility for benefits programs like Medicaid stems from the growing need for such a service once the Public Health Emergency (PHE) ends. Crouse specifically pointed towards Medicaid redetermination as the most common use for EV.

Key benefits for Medicaid reassessment include:

  • Increased accuracy and efficiency of eligibility determination
  • Reduction in fraud and abuse
  • Difficultly current systems have at tracking beneficiaries
  • Customization to states’ needs
  • Possibly integration with multiple benefit programs (SNAP, TANF etc)

Crouse stressed that states must take immediate actions to receive the full benefits of EV solutions. He pointed to cases studies showing that states that implemented such technology saw colossal savings during the first year as clearly ineligible beneficiaries were removed from the program. He defined these early removals as “low-hanging fruit” and included individuals that have moved out of state or had passed away; however, savings continued for years to follow as asset returns continued to remove ineligible members from the system.

The push for such technology exceeds the current need for resource-saving, as Medicaid reassessments are projected to increase in urgency at the beginning of 2022. During COVID, Medicaid eligibility requirements were loosened, and redeterminations were waived. Both factors have been scheduled to end with the PHE. Coupled with the 13.9% increase in Medicaid enrollment during the pandemic, states will be hard-pressed to find a solution for the astronomical number of individuals they will need to reassess for coverage (using different parameters than what are currently in place) over one year. Despite no official end date for the PHE being announced, states must start planning how they are going to undertake this large task without overwhelming their current system.

Utilizing the Cloud Imperative for a Proactive Approach to Critical IT Systems

Bob Nevins and Dean Ierardi from Oracle highlighted the three major benefits that result from shifting to cloud-based solutions:

  1. System Confidence
  2. Improved Choices
  3. Lowered Costs

Confidence Regarding Security and Automation

The isolated systems that characterize cloud solutions provide robust security and prevent unauthorized individuals from accessing sensitive data. Physical data centers have several back doors that do little in terms of preventing malicious individuals from making their way towards private information. The isolated nature of the cloud prevents these back doors from existing in the first place.

The independent and autonomous features of the cloud provide benefits beyond security. Autonomy eliminates human error and reduces administrative overhead. Because cloud solutions are modular, they should perform self-maintenance and scale effortlessly without the worry of impacting adjacent solutions. This devotion to growth and improvements is of particular importance due to the abundance of recent legislation that creates constant compliance issues. A robust cloud infrastructure should adapt to these required changes, scale to growing needs, and always ensure security.

Plentiful Choices Regarding System Composition

State agencies have both the blessing and the curse of more options regarding system infrastructure than ever before. These options grow more plentiful by the year, and vendors continue to up the stakes and come out with the best of the best technological solutions to beat the competition. On-premise, hybrid, and multi-cloud options are among the most popular. For agencies apprehensive about transitioning to a fully remote platform can opt for a hybrid solution.

For agencies ready to fully tackle the multi-cloud option, invest in integration. Utilizing multiple modules does not mean the systems have to be completely isolated. Integration allows systems to work together and communicate seamlessly.

Lowing Cost Through Improved Technology

Costs are transparent and predictable with cloud-based technology. Strong SLAs with vendors ensure you are getting your money’s worth with cloud implementations.

Oracle expects to see a surplus of agencies transitioning over to the cloud model to take a more proactive approach to the previously mentioned benefits. “A lot of [the current needs of agencies are] driven by the pandemic,” Nevins clarified.

Gone are the days of investing all available resources into IT maintenance for data-rich but information-poor returns. COVID’s strain on agencies makes it necessary for technologies to provide scalable and instantaneous solutions to upcoming issues by providing actionable insights.

Check back tomorrow for our recap of Day 4 at MESC 2021!