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July 24, 2014

Building Tomorrow's Health and Human Services With MaaS

Posted by Brian Patt (View Profile | View All Posts) at 9:29 AM

The discussion about Obamacare heats up [Source: http://www.youtube.com/watch?v=Xxz7foLoLrU]

States face a balancing act. They need to comply with regulatory mandates to expand health insurance coverage under the Affordable Care Act (ACA); an act that's been the focus of heated debates, countless delays, and intense scrutiny by millions of American taxpayers. At the same time they need to focus on the effectiveness and delivery of health and social programs to achieve triple-aim: improved healthcare processing, outcomes and lower costs.

Health insurance exchange (HIX) implementation has been one of the most complex mandates that states have had to address within stringent timelines. States have faced many challenges from dynamic regulatory requirements to unprecedented transformation of processes and technologies across jurisdictions in order to comply with this mandate. Timelines and evolving requirements have shifted the focus from delivering care and service to implementing the required technology quickly to achieve compliance.

States need to shift their focus back to healthcare and social welfare from IT and compliance. But how? The answer is simple--by relieving themselves from the burden of complex and costly IT.

Consider health exchanges as an example. As states transition from the federally facilitated marketplace (FFM) or build-out/replace existing state-based marketplace (SBM), they need a solution that helps them comply with ACA mandates and configure and deliver programs in a sustainable way. Such a solution should realize three key design points:

  • Integrated programs and citizen experience to integrate the delivery of various health and social programs - accessible via unified experience to citizens
  • Sustainable operations that address short-term funding mechanisms and build manageable OpEx cost structures and levers to lower healthcare costs
  • Dynamic compliance with continually evolving legislations and regulatory mandates

Decoupling IT from the equation and acquiring right capabilities "as a service" is key to re-focusing on the core missions. I believe, the future for state health and human services is a healthcare "marketplace-as-a-service" (MaaS) - that delivers state health insurance marketplace as-a-service and offers the required flexibility to integrate various health and social programs without the complexity and costs of IT. As a cloud-based platform, MaaS can help states meet today's healthcare reform mandates with a sustainable operating model and can enable integration of state health and social programs without being entirely focused on IT.

I see greater interest from states in leveraging pre-built technology - "in-a-box". "As-a- service" model goes beyond by offering the same capabilities in an OpEx model built and operated by a third-party. This is critical to the innovation and extensibility needed for today and tomorrow. A robust service model helps states reach the end-state faster, with less risk, and allows them to focus on healthcare and outcomes. Such a solution for a state HIX has three distinct attributes:

  • Core functionalities and interfaces with federal and state systems - e.g. eligibility, enrollment, case management, citizen outreach. The core must be common to states to make the model consistently viable. But, dynamically compliant with changing requirements to legislations and Centers for Medicare and Medicaid Services (CMS) guidelines
  • Configurability to state specific programs and business rules to address unique requirements
  • Connections to state program extensions such as Medicaid and partner or third-party value added services "plugged-in" via standard APIs targeting healthcare, costs, and outcomes

By design, such a marketplace will be a multi-tenant platform, allowing multiple states to leverage the common core and shared infrastructure to lower operating costs, while still configuring the platform to meet state-specific needs. As a pre-built and third-party operated platform, MaaS would meet existing and future CMS requirements. Platform's OpEx model and ability to "plug-in" various third-party services like social enterprise models for citizen engagement, healthcare analytics for actionable insights etc. will bend the healthcare cost curve in the long-term by increasing citizen accountability for their own health, while targeting specific health and social issues and needs.

Affordable Care Act has catalyzed everyone involved to connect citizens with care. Yet there's a lot more to be done. MaaS will be the way for states to deliver improved care and outcomes at lower costs, making healthcare more affordable and effective, which is vital for the long-term success of the nation's healthcare system.

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