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The Medicaid Enterprises Systems Conference (MESC) ended on a positive note by discussing how analytics has been used by state Medicaid agencies to solve the opioid crisis and how Florida has successfully modernized its member service experience.

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

Solving the Opioid Crisis with Analytics

The opioid crisis has affected nearly state, and governments are still trying to prevent new cases while dealing with the aftermath of past cases. Medicaid programs deal with the brunt of the crisis through reporting, analytics and outreach efforts. Michael Sasko, Vice President of Government Solutions at Softheon, spoke with representatives from Indiana and West Virginia’s Medicaid agencies to learn how the states have used data and analytics to make tangible progress on their opioid crisis. Michael Sasko leads all business development efforts for currently deployed solutions and future product innovations in the government sector. West Virginia described how it uses tools associated with Softheon’s Integrated Eligibility solution to analyze and compare opioid use with other metrics, such as emergency department visits; identify members who may be “doctor shopping”; and, identify providers and pharmacies with unusual prescription practices. In addition, the state analyzed medical conditions to create care plans for members using opioids.

Indiana learned from 2013 data analysis that opioid misuse is strongly correlated with infant mortality with the raw infant mortality rate doubling the average rate if the mother abuses opioids. The state has used this knowledge to engage relevant members in its Right Choices Program, which monitors member utilization and, when appropriate, implements restrictions for members who would benefit from increased case coordination. Part of the Program is focused on reducing high utilizers of controlled substances.

Modernizing the Member Service Experience

Damon Rich of Florida’s Agency for Health Care Administration (AHCA) described how the agency recently introduced new approaches to supplement the traditional approaches to the member service experience. Eng Tan of Automated Health System conceded, “Forty percent of Medicaid adults do not use email.” The agency introduced a member portal, mobile app, paperless notices, chatbot and texting in order to deliver more effective care to members. Rich said: “In 2010, we helped by phone calls, face-to-face, mail, and website.  In 2014, we expanded into an interactive voice response enrollment with a PIN. In 2017, we start to see the tipping point between mobile and desktop; we had email and outbound texting.  In 2019, we saw chatbots and paperless e-notices.”

In 2020, he said the agency will work on EVA 2.0, which will involve speech and analytics. EVA stands for Enrollment Virtual Assistant. Tan said, “She was able to work 24/7.  She is powered by Azure Bot Services, allowing us to operate quickly.  Our approach is to roll it out, and then evaluate it to see what’s working and what’s not working.” Tan described a reflective process where AHCA and its vendor stop periodically to analyze what is most effective. For example, “We realized that a lot of people do not like providing their email.  So, we quickly changed it to them just using a username.” He added, “We started tracking transactions started but not finished.  A lot of people measure what worked and they don’t measure what didn’t work.” Rich also discussed the value of using new technologies, such as artificial intelligence, machine learning and heat maps, to improve the member experience.



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