2023 State Healthcare IT Connect Annual Summit

Community Connect Workshop

Managing Medicaid programs through business and technological change has never been more complex. The North Carolina Division of Health Benefits, NC Medicaid, is leading Medicaid Transformation, successfully moving to Medicaid Managed Care delivery, while undertaking technological innovation in support of operational excellence. Legacy MMIS has been leveraged to support Medicaid Transformation while embarking on a parallel effort to replace the monolithic legacy platform with a modular system.

This session discusses the Medicaid governance structure that is enabling NC Medicaid’s alignment of business goals while advancing MITA maturity and ensuring continuity of CMS enhanced federal funding through Streamlined Modular Certification (SMC). SMC presents unique challenges due, in part, to the integration of modular solutions as well as the complexity associated with adopting and supporting governance structure and policy development.
 
Session facilitators will illustrate how the existing Medicaid strategic governance model has been enhanced to support a business-driven Medicaid Enterprise System (MES) project. The Medicaid governance model is a hybrid-agile structure that builds upon eight business units (Finance, Member, Provider, Analytics, Compliance, Managed Care, Benefits, and Care and Quality) whose members participate in cross-functional teams responsible for vetting operations and program changes. Further, each business unit is supported by six capability teams (Program Design and Actuarial Services, Technology, Procurement and Contracting, Legal, Communications and Engagement, and Staff Training and Staff Readiness) in order to ensure business needs are met within each technology product.

The plenary will focus on organizational development, and operational readiness to establish OBC, SMC processes as a strategic enterprise function. State and federal presenters will share insights on best practices, lessons learned, and updates on guidance. 

As an early adopter of unwinding from a public health emergency, Arizona has a unique perspective on the execution and project management of unwinding. In this session, the state along with CNSI, will share complexities, its overall experience, lessons learned, considerations, and strategy behind unwinding from a pandemic.

You know the old saying 'if you know one Medicaid program, you know one Medicaid program'. With programs designed to meet the unique needs of a state's population, each state has its own distinctive needs when it comes to its Medicaid Enterprise technology. Join this panel discussion of state speakers to learn how they each began their unique modular MMIS modernization journey and the lessons learned along the way. States will walk us through how they assessed their legacy system, researched feasible modernization solutions, and decided on their modernization approach. Learn about the steps they took to execute their approach and their experiences so far with implementation. States will share their planning strategies, their approach to CMS requirements, how they developed their roadmaps, and how they prepared their organizations for managing a large, complex, and long-term project. By learning from those who have gone before, we hope to inform states that are embarking on this effort, as well as provide lessons learned for states with in-flight modernization projects.

Consumer needs and expectations of government services have significantly increased, largely due to the rippling effects of the pandemic. People expect the same kind of engagement from their government as they receive from leading consumer brands — fast, seamless, and personalized.
 
By applying human-centered design, the consumer is the focus of the development process. It uses collaborative and interactive methods to help understand the consumer’s challenges and pain points in order to identify an actionable path forward for program improvements. Human-centered design asks two important questions: “Who are our customers?” and “What are we trying to achieve?” By truly understanding the consumer, government programs can successfully deliver services that meet consumer’s access and engagement needs. Ultimately achieving better outcomes.
 
This session will highlight how some states leveraged human-centered design to identify and address social needs as well as advocate for a customer-centric journey that evolves the way stakeholders support their communities. Exposure and access to human-centered design can help inspire pragmatic and innovative changes at all levels
of government.

State leaders find themselves in varying phases of their Medicaid Enterprise System (MES) transformation journey. Those farther along have helped pave the way, learning from mistakes, and celebrating hard-fought successes. Experienced states have evolved their strategies to adapt to changing business needs.
 
State leaders now entering the planning phase of their MES transformation have the great benefit of learning from the leaders before them. Moreover, given the rapidly evolving nature of transformation in a multi-vendor environment, state leaders at any phase of their MES journey will benefit to learn from and connect with the others successfully pioneering change at all stages of transformation.
 
Please join us for a collaborative roundtable discussion where you will have the opportunity to interact with leaders from Florida, Alabama, North Highland, and other states to discuss key learnings from MES transformation efforts and share innovative ideas.

IBM Garage™ is an end-to-end delivery model for accelerating digital transformation. It guides how you work by bringing together an open, seamless set of practices with a human-centric, outcome-first approach. It helps you generate innovative ideas and equips you with the practices, technologies and expertise to turn those ideas into business value in weeks. 
 
At the heart of the IBM Garage is Enterprise Design Thinking: a framework to innovate and solve our users’ problems at the speed and scale of the modern enterprise. We think the systems of the world should work in service of people. Enterprise Design Thinking aligns our teams on ideas and actions.  It helps our teams not only form intent, but deliver outcomes - outcomes that advance the state of the art and improve the lives of our team members and the people we serve.
 
When you work with IBM Garage you bring human experiences and outcomes into focus. You empower your teams with thought-leadership and the authority to turn ideas into outcomes. You adopt leading technologies, speed up solution development and measure the value of everything you do.

The challenge of transforming the Medicaid Enterprise System (MES) to achieve better business outcomes in a multi-vendor environment is highly complex. It consists of a collection of teams comprised of diverse groups of humans, applying their experience, processes, and technical tools towards a common goal. In this roundtable, states (Alabama, and Tennessee) will share their approach to successfully engaging their business partners. Each state will discuss the importance of the concept of “Begin with the End in Mind” was to MES Modernization. Organizational culture, project traditions and other factors that create hurdles to their project success along with what strategies can be deployed to overcome these hurdles will be discussed. Of particular interest is how our traditional approach to vendor management may need to evolve in this Multi-Vendor environment. While these challenges cannot be eliminated altogether, they can be mitigated through effective Planning, Governance and Organizational Change Management strategies.

Key Takeaways:
At the end of the session, the panel members and the participants will be able to take away the following

• Planning considerations and activities that can guide improving business partner engagement
throughout MES Multi-Vendor Modernizations
• Examples of MES Modernization Pit Falls That Can Be Avoided – State Examples
• Examples Of Best Practice and Lessons Learned from MES Multi-Vendor Modernization Projects

The Alabama Medicaid Agency (AMA) realized early in their modularization/modernization planning that they needed to establish the organizational structure to lead and manage their Alabama Medicaid Enterprise Systems Modernization Program (AMMP). This realization resulted in the creation of the Medicaid Enterprise Systems Division in 2019. Moreover, staffing projections for this new division necessitated the need to augment the team with skill sets that were not readily available in the state personnel system. As a result, the agency awarded a contract in April 2020 to NTT DATA for Project Management Office (PMO) consulting and support.

In this session, you will first hear from AMA on how they built and staffed the organizational structure that also defines the roles and responsibilities of agency staff and how they have and will incorporate vendor teams into this structure. AMA and their vendor partner, NTT DATA will also describe how they established the program governance, methodologies and approach to procurements, leveraged productivity tools, as well as lessons learned throughout the entire process.

As the role of health information exchanges (HIE) continues to evolve, so do strategies for funding and sustainability. Federal funding remains critical to support development and ongoing operations. However, as the requirements for federal funding change, the importance of collaboration between states and HIEs has never been more essential. Many states and HIEs are learning as they go, and in many cases, gaining inspiration from other states’ efforts to sustain and/or grow funding for new and operational HIE efforts under Medicaid Enterprise Systems (MES). 
 
In FFY 2020 and 2021, New Mexico’s state-designated HIE, SYNCRONYS, received federal funding under the HITECH Act and SUPPORT Act Advanced Planning Documents (APD) process to build infrastructure and capacity for data exchange, added value services, and support for provider integration.

This roundtable will map New Mexico’s journey for HIE certification, which began in early FFY 2023. Terri Stewart, Chief President and Chief Executive Officer of SYNCRONYS, will discuss collaborative efforts with the state Medicaid agency with important lessons learned related to requirements, documentation, and timing. Participate in and contribute to our conversation as we learn about and share methods used for developing state-specified outcomes-based measures and cost allocation strategies with practical tips for working with CMS and MITRE during the certification process.

With the impending expiration of the Public Health Emergency (PHE), states have begun planning to reverse the changes made to state eligibility and enrollment systems to respond to the pandemic, including policy, programmatic, and systems changes that must be unwound.

Resuming normal operations is no small feat given the number of disaster relief efforts implemented, and key processes that states need to bring back into pre-PHE statutory and regulatory compliance. This includes processing applications and redetermining eligibility for beneficiaries enrolled as of or after March 2020, completing verification of self-attested information provided during the PHE, ensuring accurate and timely notices are sent to beneficiaries regarding changes in coverage, mitigating coverage termination impacts and burden on their most vulnerable populations by transitioning individuals between coverage programs and/or State and Federal Marketplace QHPs, and the list goes on. Flexibilities have also been implemented through waivers and other disaster relief state plan amendments and necessary technology and process improvements applied to E&E programs that many states may wish to carry forward in the post-pandemic environment.

With the expiration of the PHE, states will share the actions they have taken to prepare and begin the unwinding process. A panel of state leaders will discuss their experience and lessons learned from their unwinding planning efforts, focusing on positive outcomes achieved through the pandemic response and ways their systems and programs have changed for the better.

Learn from real-world experiences how State Medicaid leaders are planning and transforming critical infrastructure and systems through orchestrated management of procurement, modularity, and certification processes linked to achieving key outcomes for constituents and program administrators.       
 
State leaders and Conduent’s experts share their insights, challenges, and victories as they discuss how using an organizational-change approach that includes not just a focus on systems and technology but also the people, processes, funding and specific outcomes.  This agile approach creates a holistic, goal-driven transformation that considers optimally structuring procurement, to determine the best modular IT architecture and achieving streamlined modular certification that ensures Federal funding.
 
Key takeaways:

• MES Procurement
  • Optimizing the procurement structure
    • RFP vs. invitation to negotiate
    • Procurement’s new role
      • Engaged earlier in negotiations (before the RFP is signed)
      • Managing the multi-vendor environment
• Modularity
  • Configuration-driven architecture vs. Enterprise architecture
  • Orchestration and integration
  • The benefits of multiple-vendor management
    • Improved vetting and selection of vendor capabilities
    • Creates true plug-and-play architecture

 

• Outcomes-based Transformation
  • Program and outcomes prioritization
  • Understanding CMS’s new Streamlined Modular Certification (SMC) process
  • Managing and achieving Certification

What challenges does your Agency face? Improving service delivery for citizens? More work/home life balance for your HHS staff? Less heartache for Providers? Outcomes that show CMS your SMC progress?

The MES path ahead should be guided by a detailed roadmap that connects your outcomes and goals to target workflows, an IT architecture, and an integration approach that are tuned to deliver your outcomes. The roadmap identifies the path to implementing the identified improvements in your MES business processes. This can include process-only changes, interim changes to your IT systems that move the needle on desired outcomes short of full module replacement, and the plan for acquiring the modules you need and their deployment order. The details of roadmap, architecture and integration approach should define your module procurements and APDs, reducing the burden on your staff. Finally, those details empower your Certification Plan, starting on Day 1. Does your MES roadmap have this?

These questions and goals drive the “Integration Imperative” Medicaid Agencies face today. To get to these Program and Policy Outcomes, you’ll need an integrated team, integrated governance for both people and data, comprehensive program workflows to deliver the outcomes, and underneath it, a MES that provides seamless end-to-end business services.

In this session, KPMG and its clients will share lessons learned from multiple MES modernization projects – business and IT challenges, how they resolved them, and their recommendations going forward.

The Medicaid Information Technology Architecture (MITA) initiative sponsored by the Center for Medicare and Medicaid Services (CMS) and governed by the MITA Governance Board (MGB) is intended to foster integrated business and information technology (IT) transformation across the Medicaid enterprise to improve the administration of the Medicaid program. The MITA initiative is a national framework to support improved systems development and healthcare management for the Medicaid enterprise. MITA has several goals, including the development of seamless and integrated systems that communicate effectively through interoperability and common standards and processes.
 
In order to provide strategic direction and tactical oversight for the MITA initiative, CMS established the MGB which is being revitalized in 2023 with a new focus on updating the MITA framework to reflect current business and technical best practices in Medicaid. The Board is a cohesive, effective group that will ensure MITA continues evolving to support a common Medicaid business and information technology framework for states and vendors. The MGB is a non-Federal Advisory Committee Act (non-FACA) organization.
 
This session serves as the first in-person board meeting of 2023.