State Progress on ACA, IT Procurement Models & Analytics 3.0: An Interview with Eric Paternoster
Rob Waters, VP development with Healthcare IT Connect sat down with Eric Paternoster, CEO Infosys Public Services, to discuss the challenges States have faced in implementing ACA, HHS interoperability and how models of procuring IT and analytics tools will help define the path towards meeting with the triple win objectives.
Rob Waters: Eric, could you tell me a little bit about yourself and how you came to lead the Infosys Public Services organization?
Eric Paternoster: I am the President and Chief Executive Officer at Infosys Public Services, which is a US headquartered subsidiary of Infosys (NYSE:INFY). Infosys Public Services offers consulting and technology solutions to help public sector and healthcare organizations improve mission outcomes and patient centric care
Before being named CEO of Infosys Public Services, I led the insurance, healthcare, and life-sciences business unit of our parent company Infosys until 2010. At the time, we saw the coming convergence of commercial and government healthcare. So we consolidated our go-to-market focus and investments in the healthcare and public sector space into a separate subsidiary to better serve our clients. Thus, we have been able to bring innovative solutions to leverage the synergy between healthcare and public sector while also tapping into 30+ years of commercial experience and delivery excellence Infosys is known for in assisting clients with the unfolding transformation.
RW: What do you see as some of the main challenges States have faced in implementing the Affordable Care Act and what have been some of the lessons learned to date?
EP: Affordable Care Act has seen a lot of heated debates, frustrating delays, and intense implementations. Setting up of health insurance exchanges has been one of the most complex mandates that states have been required to address within stringent timelines.
Despite extensive effort and investment, 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. All these occurred concurrently, thereby significantly adding to the program complexity. Timelines and requirements put the focus on compliance and away from education and outreach to citizens.
States have learned from this experience. In addition to leadership, communication, and risk mitigation / contingency planning for such a complex undertaking, a key takeaway has been the shift in the approach to technology adoption and program management. We see greater interest in leveraging proven or pre-built technology rather than building it. This approach not only makes contractors more accountable, but also helps states reduce implementation time, increase agility and flexibility to adapt to evolving requirements / regulations. Thus states can focus strategically on systems integration with existing state health and social programs and citizen engagement to improve program delivery, care and outcomes.
RW: The ACA, and the implementation of the exchanges in particular has highlighted the need for States to re-think the way they procure IT systems, how have the conversations you’re having with States changed over the past few years?
EP: Procurement has always been a tricky issue. While the pace of procurement reform has been slow, we are witnessing steady improvements. A big change we see is the extra effort states are putting into developing RFPs. There is an interest in engaging with contractors / vendors and commercial organizations to get insights on requirements, benchmark processes, and technologies. We also see increased collaboration between agency CIOs and the procurement office to streamline the process through staff training, RFP review etc.
States are also more open to Software-as-a-Service (SaaS) and proven Common-Off-The-Shelf (COTS) products to leverage technology rather than build it. States recognize that these models can help accelerate implementation, adopt standardized practices, minimize risks, and simplify governance thus help deliver outcomes quickly. They are currently developing standards for cloud-based / SaaS offerings, and favoring ‘licensing’ approach over ‘acquisition’ to fairly compare with traditional on-premise infrastructure.
RW: Where are the States now with respect to ACA requirements, where do they go from here?
EP: ACA has catalyzed action to connect citizens with care, particularly through health insurance marketplaces. While states focus on expanding coverage to constituents as mandated by the ACA, they cannot lose sight of the core mission to deliver effective health and human services programs that improve health outcomes at lower costs.
Health insurance marketplaces are only a step towards realizing this vision. States need to integrate health and social programs on a common platform so that citizens and other stakeholders have a unified view of the individual and family. The platform should offer the core functionality of HIX yet be configurable to state specific rules and extensible to programs such as SNAP/TANF. Such a platform will also foster innovation by attracting healthcare organizations, technology vendors and data providers to form an ecosystem offering range of products and services that can impact health outcomes.
RW: Given the uncertainty about the federal funding for HIT programs, how do you see states implementing their ACA mandates while still building an integrated health and human services ecosystem?
EP: Federal funding was a key enabler to get states’ ACA programs started. However, 90/10 funding for Medicaid is going away as are the HIX grants. As states look to transition from the federally facilitated marketplace (FFM) or build out their existing state based marketplace (SBM), they require innovative solutions. Alternative solutions should provide states control of how they configure and deliver these services in a sustainable model that optimizes investments with least taxpayer burden.
Adopting a cloud-based marketplace platform, delivered as a service, helps states meet today’s ACA and HIX mandate with lower cost and sustainable operating model, while relieving the states from operational burden of compliance and IT. Such a model, if designed with common core for HIX functionality and standard interfaces for state and federal, enables multi-state or regional sharing to lower costs even further through economies of scale. The challenge will be to ensure configurability to address individual state needs while leveraging shared infrastructures and services.
RW: Some State Medicaid leaders have argued that Federal funding programs for HIT investment are not well aligned to services based models such as MITA, do you have any thoughts on how this could be improved?
EP: Just as CMS has been very creative and has let states define new programs, the procurement processes also need to be adjusted. An interesting example is that the 90/10 funding for Medicaid expansion has led certain states to avoid sharing and splitting costs that would have been higher than running individual programs.
RW: There is a huge buzz around data analytics and improved care coordination to meet with the ‘triple aim’ objectives, however most States are only in the early planning stages of establishing the required data governance and infrastructure to support these tools. How do you see this space developing over the next five years?
EP: Achieving the ‘triple aim’ objectives requires coordination and collaboration across healthcare and social programs. We see limited progress on this primarily because states are focused more on compliance and meeting current requirements. Complexity of existing technologies and reliance on legacy systems are also constraining factors.
The next few years will see states actively working to address this situation. Citizen outreach and engagement (via traditional and emerging channels such as mobile and social media) and analytics 3.0 (use of big data) will be key to increase consumer accountability for their own health and deliver better care and service at lower costs. Analytics will enable a proactive and predictive approach to healthcare, identifying critical issues and population segments and directing state resources and programs to those needs; it will also improve program effectiveness by reducing fraud, waste and abuse. States will extend their foundational HIT implementations like health insurance marketplaces with solutions to create an integrated HHS ecosystem that improves access to programs and delivers a unified experience to citizens. Evolution of this approach will coincide with the change in technology adoption models. As I mentioned earlier, states will move towards better leveraging and applying cloud/SaaS technologies and other solutions built and managed by vendors/third-parties rather than building it on their own, thus refocusing on mission outcomes.
Eric Paternoster will be presenting the Lunchtime Keynote at the 2014 State Healthcare IT Connect Summit, in Partnership with NASCIO, April 01-02, at the Grand Historic Venue, Baltimore MD. Joining Eric on the panel will be Dan Schuyler, Former Director of Technology for the Utah Health Insurance Exchange, Senior Director of Exchange Technology, Leavitt Partners.
Learn more about the Keynote Session, Beyond HIX and ACA: Building Tomorrow’s Health and Human Services here
To attend the 2014 State Healthcare IT Connect Summit in person please register here