Governments are overwhelmed balancing consumer expectations, aging workforce, regulations, rapid technology change and fiscal deficits. This blog gathers a community of SMEs who discuss trends and outline how public sector organizations can leverage relevant best practices to drive their software-led transformation and build the future of technology – today!

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Rethinking health and human services delivery: Insights from 2016 State Healthcare IT Connect Summit

The State Healthcare IT Connect Summit is an annual event that brings together thought leaders from the public and private sector to share ideas and benchmark implementation strategies of state health IT systems. 

Infosys Public Services was a Silver sponsor at this year's conference which saw more than 500 attendees from 20+ states, the Centers for Medicare and Medicaid Services (CMS), and a wide spectrum of industry vendors.

There were insightful discussions on various imperatives for health and human services organizations (HHS) like the integration of health and human services programs, citizen-centric service delivery, modular procurement and delivery, and analytics. Of the various imperatives discussed, I believe the following three will have an immediate and significant impact on the existing strategies and service delivery models of HHS organizations:

1. The shift in funding by CMS from "end to end" Medicaid Management Information System (MMIS) solutions to modular solutions i.e., provider, claims, member, etc. 

Most states depend on a single MMIS platform and vendor to administer their Medicaid programs.  The new direction by CMS to fund only modular MMIS modernization projects has created a lot of uncertainty among the states.  On the one hand, they want to take advantage of the 90/10 funding available from CMS for modernization projects. On the other, they are not sure how to go about replacing their current vendor.

States seem to be struggling to understand how to transition from their current single vendor model to one that may involve multiple vendors providing best of breed components.  The new modular world will also see an increase in the number of vendors and point solutions/offerings that states will have to choose from. Given their limited bandwidth and expertise, this could get overwhelming. However, agile procurement and reduced time to delivery will considerably reduce the risk as compared to a multi-year full implementation. This is a new game and the rules are continuing to evolve. 

2. Continued development of payment reform strategies, essentially quality and efficiency based reimbursement methodologies.

Payment reform strategies were introduced as a way to improve health care quality and reduce costs.  Payment reform initiatives are highly dependent on the ability to collect data from multiple, disparate sources, clean and standardize it, and use sophisticated analytics to arrive at valid comparative metrics.  The increasing demand for data is placing a tremendous burden on the provider community, especially the already beleaguered primary care physicians.  While various speakers acknowledged the problem, no one had any concrete solutions; and as analytics grows in importance, the situation is likely to get worse before it gets better.  Fraud and abuse continues to be an area of interest but increasingly provider payment will be tied to value.  Determining value will require more data including clinical and claims data and powerful analytics tools.

3. Increased focus on integration of different health and human services programs

Building an integrated eligibility system is crucial to deliver a connected health care and social program experience to citizens while continuing to reduce costs. Many HHS organizations still struggle to turn the integrated eligibility concept into a reality.

An ideal end-to-end integrated eligibility system (IES) consists of several components of varying complexity. Each state is at a different level of maturity when it comes to their IE implementation.  State HHS agencies face significant challenges in aligning their vision and strategy with the practicality of funding, formulating strategies to define core vs. peripheral programs, realistic implementation timelines, and bringing the stakeholders up to speed including implementing a comprehensive change management program.

20+ executives from different agencies participated in a roundtable hosted by Infosys Public Services to discuss their point of view, share real-world examples and practical strategies to build a robust Integrated Eligibility system. A framework was discussed that could help HHS organizations build their integrated eligibility system successfully. The framework outlined the need to flesh out policy requirements early, select the right implementation approach, truly partner with the systems integrator, and innovate from outside-in. But doing this is not easy and requires HHS organizations to rethink the way they define and execute their IE programs.

Many of the new initiatives presented and discussed at the conference have been in the works for some time.  It is clear that modularization of MMIS systems and value-based reimbursement are moving from the drawing board and pilot stages towards the mainstream.  Several states are heading in the right direction.  Many others have a long way to go.  However, the technology is available and CMS is pushing the states to move in this direction. So, despite the uncertainties, states need to take steps quickly to address these imperatives and significantly improve health care, outcomes and costs.

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