The Medicaid Enterprise Systems Community (MESC) is a national conference and community for state, federal, and private sector individuals to exchange ideas related to Medicaid systems and health policy affected by those systems. In this blog series, two North Highland experts leverage insights gathered at this year’s event to discuss key takeaways and trends you’ll want to know about.
Several leaders from North Highland’s Health and Human Services team recently joined top federal, state, and industry participants at the 2021 Medicaid Enterprise Systems Conference (MESC) in Boston. MESC brings together thought leaders from the public and private sectors to share ideas and information related to Medicaid systems and initiatives. Two major themes surfaced at this year’s conference: improving member and stakeholder experience and navigating the ongoing shift to modular Medicaid systems. Together, these themes underscore an important insight about the future of state Medicaid agencies: collaboration will chart a brighter course.
People are the reason we do what we do
New England State Consortium (NESCO) Executive Director Elena Nicollela set the tone for this year’s conference by acknowledging that, although the pandemic has brought the role of data and systems to the forefront, it’s the collaboration in forums like MESC that matters most. Why? Well, because ongoing partnership across industry leaders ultimately makes Medicaid programs successful for the people who need them. Collaboration plants the seeds for breakthrough thinking and innovation, ensuring technology is best used in support of the member experience.
Medicaid enrollment has soared, with close to 80 million members now. About 25 percent of the U.S. population is covered by Medicaid. The pandemic, coupled with Medicaid expansion in many states, has resulted in a more diverse Medicaid member population than in the past—bringing a broader mix of consumer preferences. In particular, more members now favor the convenience offered by digital, people-first technology. After all, a greater share of Medicaid members have participated in the private and employer-sponsored health insurance market, bringing with them expectations from those past experiences.
With these trends, industry leaders are turning to technologies that were once considered emerging, such as robotic process automation, artificial intelligence, and machine learning. These capabilities enable the more seamless, convenient, digital experiences that members expect. They can support existing and new business processes by increasing speed-of-service and providing members, providers, and other stakeholders with self-service capabilities. While new technologies and systems modernization initiatives may be uncharted territory, looking to other states and taking part in collective procurements can spur innovation.
Addressing modularity’s challenges presents us with real opportunity
Innovation is certainly key in Medicaid systems modernization initiatives; however, state agencies, solution vendors, and other stakeholders recognize that innovation and technological improvements must be balanced with an honest assessment of acceptable levels of risk. After all, the stakes are high: These systems support programs that attend to the medical needs of tens of millions of Americans. The skills needed to maintain these legacy systems are harder and harder to find—yet systems cobbled together with brittle architecture make it hard to fix one thing without breaking another. We can see how these infrastructure limitations negatively impact the Medicaid enterprise. In particular, they diminish essential member and provider interactions, such as those in the contact center.
Florida Medicaid recognized that the move toward a modular Medicaid Management Information System (MMIS) could exacerbate fragmentation in the member experience. So, the agency tackled the issue head-on in its modernization roadmap. Its Unified Operations Center approach integrates operational activities for an improved customer experience that’s also more cost-effective. It eliminates redundant communications infrastructure across modules and allows for a more flexible staffing model, resulting in smoother customer issue resolution and fewer call transfers.
For most states, modular solutions introduce more procurement activity, presenting tremendous opportunity for greater cross-industry collaboration and innovation. States are looking at ways to shorten procurement cycles by collaborating with and leveraging due diligence performed by other states. A panel of presenters from Connecticut, Georgia, Montana, and Missouri discussed their participation in NASPO ValuePoint, a cooperative purchasing program that facilitates public procurements using a lead-state model. In this model, a lead state works with NASPO ValuePoint to assemble a sourcing team, develop the components of the RFP, and submit the RFP to CMS for approval. This lead state releases the solicitation and recommends awards to NASPO ValuePoint. Upon final approval from CMS, master awards reside at ValuePoint for reuse by other states. This helps to streamline the procurement process in several ways, including reducing the risk of protest due to more transparency and competition, greater vendor participation, and more robust partnership across states. Master agreements have been awarded to numerous vendors for Provider Services, and an initiative to establish agreements for Third-Party Liability is well underway.
Nicollela’s opening remarks about the promise of cross-industry collaboration rang true throughout the conference. Navigating the complexities of modernization, capturing its opportunities, and delivering on evolved member expectations call for new ways of thinking about how we work in teams. Keynote speaker Michael Hendrix, author of Two Beats Ahead: What Musical Minds Teach Us About Innovation, noted that listening, collaborating, and experimenting are musician mindsets that we can all adopt in creating solutions that help the people at the center of everything we do. He offers that at the center of good collaboration—in “creative work” as well as in technology (which is creative work, after all)—is peer respect—a shared optimism that the talents we bring together in a team will create something new.
Click here to read part one of the series.