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The Medicaid Enterprise Systems Conference (MESC) continued day 2 and day 3 by discussing the most pertinent issues facing Medicaid: modularity, user acceptance testing, automation, mobility and enterprise transformation. Attendees are addressing state challenges and keeping the Medicaid modernization at the forefront of proposed solutions.   

In case you were not able to attend, here is our recap of key topics discussed: 


Edward Dolly, Director of the Division of State Systems at the Centers for Medicare and Medicaid Services (CMS) spoke with Mitzi Hochheiser, the Chief Technology Officer of Louisiana’s Medicaid agency, about the agency’s recent efforts to solve a discreet program problem within 12 to 18 months. In order to create a successful modular solution, Hochheiser said: “My one piece of advice is to start early and often with CMS. Also, know what you’re trying to accomplish. Have a clear goal, or north star, and keep it in mind. Make sure you know what you actually want before you get it.” Another speaker from Chicago underscored the importance of collecting feedback from others throughout the process: “We had a policy workstream that had 400 people on a distribution list, and quarterly we collected feedback from them, in order to hear the voices of the providers and the individuals receiving services from them.”  

User Acceptance Testing  

As states adapt to the modular mandates of CMS, user acceptance testing in the post-production lifecycle is one of the ways to evaluate these systems. The mapping of testing to Medicaid Information Technology Architecture (MITA) business processes will help states deliver on testing goals by setting up a common language for multiple modular implementations. In addition, user acceptance testing can be traced to Medicaid Enterprise Certification Toolkit (MECT) checklists and MITA assessments. Understanding patch releases, bug fixes and performance updates are the keys to successful testing. Raymond Chin of NTT DATA did, however, acknowledge that testing requires “more time, more people.” He also stated that testing is “always about risk management.”  

Robotics Process Automation 

Texas has been working to conserve its resources by using robotic process automation (RPA) to bring efficiencies to repetitive tasks, cost-effectively improving the state’s legacy system until it completes its modernization plan. “A lot of it is manual intensive work, so if you can bring some automation,” said Anthony Schnabel of Texas Health and Human Services, “it can bring huge value.” RPA can also assist with audit and regulatory compliance by tracking the tasks it automates. By using RPA, Texas has freed up workers to work on more complex, high-value tasks. Michael Berke of Accenture said, “Our ideas come from line staff who feel the pain day-to-day and know the best places to apply automation. Every idea must be associated with an impact assessment.” Texas is currently using RPA to support provider enrollment, financial, and data management processes.  


Some states, such as Vermont and Louisiana, have included a mobile-centric approach to improve Medicaid delivery and engagement. as Dustin Palmer of Code for America noted, “We hear it from clients all the time, ‘My phone is my computer.’” The states described how they worked with organizations like Code for America to build mobile tools, such as a document uploader that securely sends eligibility documents using a phone’s camera. The states also created a text-messaging service to supplement mail remainders in order to remind consumers to take action on their coverage. Palmer admitted, “We saw pretty modest results. We saw about a 5% increase in the number of people who replied.” 

Enterprise Transformation 

Georgia, Maryland and Virginia shared how they are driving purposeful transformation through organizational and platform redesign using MITA concepts, industry standards and new techniques. Greg Williams of Ernst Young admitted, “Transformation is hard… As these systems have aged and gotten more complex, the cost to maintain has gotten higher and the number of folks who can maintain these systems has gotten smaller.” But understanding the value of automation, he said, “I want humans to be doing what humans do well. I want technology doing everything else.” Lourdes Padilla, secretary of Maryland’s Total Human-services Integrated Network (MD THINK) described how Maryland’s enterprise transformation worked across multiple departments: “We do the eligibility determination, integrated and enrollment application. The Department of Health is our single state Medicaid agency. We have a 360-degree view now. We have consolidated our control center. By being an integrator, we have advanced security.” Padilla announced plans for MD THINK to be completely web-based and mobile. She encouraged the audience to pursue enterprise transformation as it is “very cost-effective.” 

Human-centered Design 

Human-centered design (HCD) was the topic of at least two sessions at the conference. HCD is a method that places the consumer in the center of a product development solution to create new solutions that are made to suit their needs. Laura Ramos of Code for America and Dona Coffman of CMS described Code for America’s Integrated Benefits Initiative for CMS, which was built using HCD. Coffman said, “In human-centered design, one of the first parts involves discovery… We focused on feeling: how does the consumer feel about the product? We focused on their obstacles.” She added, “Another key is constantly engaging our stakeholders.” Ramos discussed the future of HCD for states while underscoring the importance of data: “One outcome we believe every state should be going toward is state and agency leaders having the real-time data for the end-to-end client journey.” She ended by offering three technical insights: mobile devices operate as critical connection hubs; passwords and accounts often become client barriers instead of safe checks; and, technology isolates clients and caseworkers from each other despite a connected process.” 

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