Author Archives: HITC Editor

According to Gartner, Artificial Intelligence (AI) adoption in organizations has tripled in the past year, and AI is a top priority for many CIOs. Yet early AI initiatives have a high probability of failure due to misalignment of business and technology. Some of these include identifying the right business case, having the right specialist that can marry the clarity of business problems and technologies, the complexity of the tools, the quality of data and the infrastructure to support these initiatives.

In this session, we shall discuss these and other barriers and hear from various other government attendees as to their successes and lessons learned in the adoption of AI.

Sam Hua


VP Software Engineering

As eSystems’ Vice President Software Engineering, Sam Hua leads eSystems’ Asset Development practice. He manages people, processes and assets, from ideation and requirements management, to architecture and design, development, test, and deployment. With over 30 years of software engineering experience, Mr. Hua is an expert in cloud application architecture, AI engineering, enterprise architecture, enterprise systems integration and modernization.

Mr. Hua is IBM SOA-certified and earned his bachelor’s degree in Electrical Engineering from Case Western Reserve University, graduating summa cum laude

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States are challenged with the many questions raised when considering social determinants in a Medicaid program, addressing them in practice, and using the data derived from related research to drive Medicaid planning. How do we gather useful information? How do we fund programs to address social determinants of health (SDoH)? This discussion will take a look at how some states are gathering and using SDoH data, the emerging technologies that can assist in addressing social determinants, and the ongoing supports needed to change population health through SDoH factors. Connecting population health with social elements that don’t directly fall under state Medicaid or Department of Health purview is a key factor in transforming health and human service organizations and the way they address the overall needs of their constituents. This discussion offers an innovative combination of technology, services and a switch in paradigm to supportive services instead of reactive services.

Ferdinand Morales


Vice President of Operations

Ferdinand Morales has more than 15 years of work experience in the development, delivery, and optimization of value-added quality management systems for health and human services operations. Mr. Morales currently serves as the Vice President of Operations for the New York State of Health Customer Service Center. Previously, he served as the Director of Operations for the California Health Care Options project, and as a Director of Quality Assurance. He holds a Six Sigma Black Belt certification from Villanova University and a Master’s degree in Accounting from the University of Phoenix.

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During this interactive roundtable experience, participants will gain a deconstructive view of the rationale, function, and expected results of the modules that comprise the MMIS 2020 Platform at the Commonwealth of Pennsylvania. The session will cover all modules with an emphasis on the key role an independent EDI module plays in optimizing outcomes. Speakers from the Commonwealth will also outline the key considerations that influenced their decision-making process, specifically around areas related to COTS, configurability, speed, & futureproofing.

Sam Moore

Senior Project Manager, Edifecs

Sam is the Senior Project Manager for the MMIS 2020 Platform which is a modular replacement for the current MMIS in the Commonwealth of Pennsylvania.


Shane McMillan

Public Sector Technical Lead, Edifecs

Public Sector Technical Lead for Edifecs focusing on EDI modularity, Data Quality, Interoperability and Value-Based Care use cases10+ years of pre-sales experience in State Health and Human ServicesBusiness and technical expertise in Enterprise Integration and Process Automation

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Learn how integrating PDMP information, analytics, resources and more into EHR and pharmacy management system workflow is a critical next step in the progression of optimizing PDMPs to make a meaningful difference in the opioid epidemic. The roundtable will highlight the progress made by many states via the deployment of a platform capable of:

* Identifying patients at risk of an overdose earlier
* Incorporating critical clinical solutions that empower prescribers and pharmacists to better engage patients
* Mitigating the illicit drug overdose trend with clinical tools
* Improving treatment referral capabilities and bridging the gap that exists getting patients to treatment efficiently and effectively
* Enabling communication with care teams
* Providing non-dispensation-related risk data such as non-fatal overdose, Naloxone administration, drug court data, etc.

Brad Bauer
Appriss Health
Senior Vice President
Bauer brings more than 30 years of professional experience working within commercial, government, healthcare, and strategic partner markets. His background also includes over 22 years of experience working within HCIT solutions to help enable access and mitigate risk. Prior to joining Appriss Health Bauer worked at McKesson’s RelayHealth. Brad has also worked closely with the DEA, FDA, and CDC leveraging prescription drug diversion solutions on a national scale. For the past 15 years, Brad has been focused on state prescription drug monitoring programs (PDMPs) and efforts to integrate PDMP information within clinical workflow.

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Health care quality measurement is going digital and HIEs are positioned to play a predominant role in the future of quality measurement. Digital measures create new opportunities for using the rich information in electronic data sets to assess more of what matters. This session will highlight how states are using data aggregators to supplement claims and produce validated performance measures. Hear from state and national experts as they move the needle on HIE data quality to support oversight and payment programs.

Wendy A. Talbot
MPH, AVP Measure Collection & Audit, National Committee for Quality Assurance (NCQA)
Albert Taylor
Medical Informatics Fellow, ONC/HHS
David Kelley MD
CMO, Pennsylvania Department of Human Service’s Office of Medical Assistance Programs
Dan Porreca
Executive Director, HEALTHeLINK
David Kendrick, MD, MPH, FACP
CEO of MyHealth Access Network, Chair of the Department of Medical Informatics, Oklahoma University School of Community Medicine

The 2020 State Healthcare IT Connect Summit has now been rescheduled to take place at the Hilton Hotel, Baltimore MD. on December 7-9 2020.

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A robust and healthy Third Party Liability system is a critical component of a state’s ability to ensure Medicaid dollars are spent judiciously. Ensuring that states stand prepared to leverage best-of-breed technologies to provide data-driven TPL results and transparency will be instrumental to this evolution. In this session, we will dive into the various models and tools available to or being leveraged by states to help “shine a light” into the health of their TPL program. This includes everything from health insurance premium payment (HIPP) to your retroactive insurance identification and recovery efforts, subrogation recovery efforts and cost avoidance.

We will explore best practices for using innovative technologies to improve upon increased transparency into the form and function of the TPL systems being leveraged by the States. Speakers will discuss the benefits to the TPL process, as well as obstacles encountered in developing their solution.

Michele Carpenter
SVP Government Solutions, HMS
Cynthia L. Perkins
Senior Advisor to the Deputy Secretary of Health Care Finance, Maryland
Denise Poley
TPL Offering Lead, Accenture

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As states continue transformative work to reform their health care payment and delivery systems to improve
population health, streamline service delivery and reduce costs, having the right data and data systems to support and inform those efforts is imperative to success. Throughout 2017 and 2018 the Indiana Family and Social Services Administration (FSSA) transitioned from a heavily focused reporting group to an insight-driven organization with the appropriate governance required to fully harness the power of data. FSSA, through its work with the National Governor’s Association (NGA), and in collaboration with the Department of Corrections (DOC), Management Performance Hub (MPH), Medicaid and others identified cross-party data sharing opportunities to provide solutions for complex health problems.

In this session, attendees will learn how:

  • FSSA applied for and received a technical assistance grant from the NGA to “Harness the Power of Data to Achieve State Policy Goals.”
  • How legislation would allow the Indiana DOC to apply for Medicaid coverage on behalf of inmates 60 days prior to release. This legislation intended to ensure that returning citizens had access to the necessary health coverage to help reduce recidivism and the utilization of high-cost emergency care.
  • The new DOC policy that would only be made possible with enhanced data governance and cross-sector data sharing.
  • How FSSA, DOC, MPH, Medicaid, and others worked together to improve the business process.

Through this data-sharing effort, FSSA was not only able to demonstrate that the policy change did reduce time-to-coverage for these inmates, but they also engaged the academic community to study the impact of the reduced time-to-coverage on health outcomes and population health.

Amy Lewis Gilbert, JD, MPH
Chief Science Officer, Indiana Family & Social Services Administration
Connor W. Norwood, PhD, MHA,
Chief Data Officer, Indiana Family and Social Services Administration, Division of Strategy and Technology
Jared Linder
CIO, Indiana Family and Social Services Administration
Justin Blackburn
Assistant Professor, Indiana University Richard M. Fairbanks School of Public Health
Shannon M. Stotenbur
Vice President Business Development, Optum State Government Solutions

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This cross-industry panel will provide the basis for a lively discussion on why a new mindset is necessary in the transition to modularity and modernization. Custom systems no longer make sense in a world where proven commercial off-the-shelf (COTS) products get the job done more efficiently and effectively in a fraction of the time. But everyone must be open to new ways of thinking.
In a COTS-based world, outcomes should be the measure for technology procurements. This allows states to articulate business objectives while holding vendor partners accountable for meeting high standards. CMS also sees value by focusing on outcomes as a means to simplify the certification process and minimize administrative work.

Tom Graves
Senior VP, Government Solutions, Optum
Ed Dolly
Nicole Corneaux
Medicaid Director, State of New Mexico
James Coursey
DHHS CIO, State of South Carolina
Jess Kahn
Partner, McKinsey & Co.

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Casey Burns of AWS reflects on how to effectively meet the needs of underserved constituents while navigating complex and rapid change. He recommends practical approaches to improve constituent outcomes and program efficiencies by using technologies and approaches pioneered by leading private sector technology companies.

How Health and Human Services (HHS) agencies leverage technology is key to how they deliver benefits and execute on the promise they made to the most vulnerable constituents across America.As we start to think of health more holistically, our technology needs to keep pace as we introduce more complexity and change into the system. The systems and technology approaches that are currently being used were not put in place with programs based on integrated care or social determinants of health in mind. This pace of change is the new normal. I can’t imagine a scenario where Medicaid, for example, will go unchanged for five, let alone 20 years. It’s not the reality of where we are in terms of improving outcomes using health, healthcare, and social and economic benefit programs.

Why doesn’t technology in the public sector look more like the private sector? What causes that divide?
HHS agencies could fundamentally change the way they deliver services and outcomes to beneficiaries, particularly by using new technologies and new approaches to technology, like citizen centered design and iterative development. Yet, we repeatedly hear from senior government executives that technology projects intended to improve outcomes and service delivery do not meet their initial promises. For instance, applicants for most benefits programs cannot use their mobile phone to complete an application. That’s no longer acceptable. Leading private sector companies have set a high bar for digital experiences online, and constituents now expect government services that feel like those delivered by private sector organizations. Our aim should be to provide those experiences to them as it encourages the programs themselves to be more agile, iterative, and adaptive.

Why aren’t agencies getting what they expect from their technology projects?
This is as much about people and process as it is about technology. Even in the public sector, we should be building systems that have user experiences comparable to those in the private sector. The challenge has as much to with how we think about technology and building projects, as it does with which solutions we select to build those projects. When talking with agency executives, I spend as much time sharing how Amazon built its culture of innovation or approaches developing new products as I do speaking about technology and the cloud. This makes sense, as a primary place where you see the gap between government and the private sector is not just which technology and tools they use, but it is actually about organizational capabilities and how the organization uses them to develop technology projects.

Through cloud providers like AWS, HHS agencies are now capable of using the same technologies leading technology firms use without upfront costs or expensive licensing models that lock them in to one technology. AWS helps organizations build, test, deploy, and iterate new digital services for their beneficiaries and employees using the same technology that powers

What does this mean practically?
Before Amazon launches a new business or starts a project, we go through something called the “Working Backwards” process. Amazon implemented this system to ensure we obsess about our customers in everything we do. We pose hard questions upfront and those answers help us design outcomes that will delight our customers and their constituents.

For example, using this approach with an agency, we developed a proof of concept that brings Amazon Connect, our cloud-based contact center solution, together with natural language processing. It allows child protective services investigators to get information about cases read to them while they are driving, saving time and helping investigators make better decisions.

Technology is not the end all in itself. It’s how you leverage the tools through people and processes within your organization. It is an augmentation that should give super powers and capabilities to caseworkers, administrators, and policymakers. If the tech doesn’t help make these folks attain more superhero powers, then we can do better.

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Jeff Mullins, Deloitte Consulting Managing Director and leader of Deloitte’s Data Convergence and Platforms, sat down with Healthcare IT Connect’s Rob Waters to discuss Medicaid modernization and modularity.

Rob Waters (RW): Jeff, Deloitte is the Systems Integrator on four state Medicaid Enterprise System (MES) projects. What efficiencies and innovations have you seen as MMIS systems are modernized and modules are implemented?

Jeff Mullins (JM): Interoperability and reuse are really being embraced. Clients are demonstrating a commitment to standards-based data exchanges and shifting to “real-time whenever possible” to increase the responsiveness and timeliness of processes within the organizations. Data-based decision making is rapidly evolving — leveraging inputs not previously available or accessible to drive outreach, influence behavior, manage care, and align services to improve health outcomes.

RW: What’s possible with available technologies but perhaps not yet being considered?

JM: The first things that come to mind are the mobile/digital possibilities. Portals are being integrated via single sign-on (SSO) and modernized. This expands capabilities for not just mobile portal use, but also mobile chat, video conferencing, etc. These are capabilities of a robust integration platform that can positively impact the stakeholder experience. The second thing that comes to mind is leveraging integration platform capabilities for internal and external communications to create a “single voice” for the agency when communicating, regardless of the solution or module generating the alert, notice, e-mail, etc.

RW: What are the greatest challenges you’ve encountered as the SI, and how have they been overcome?

JM: Those would be communications and scheduling. All modules must actively participate in building an Integrated Master Schedule to plan work and identify dependencies. This creates a common understanding of how integrations will be completed and end goals achieved.

RW: What’s next on the roadmap for HealthInteractive™?

JM: We are proud of our product which four state clients are currently using to modernize their Medicaid programs. We constantly reinvest in HealthInteractive™, and right now we’re very focused on expanding our integrated COTS tool suite to provide even more options for clients with preferred enterprise tools and database preferences. We also are focused on innovation to reduce maintenance activities, increase levels of automation, improve performance/throughput, and create out-of-the-box “extenders” to integrate or replace/modernize client assets such as EDI portals, correspondence generation engines, and content management solutions.

RW: What improvements do you think states can pursue as they work through the modular transition?

JM: As states are planning and working through their procurement and eventual implementation, it’s critical to examine and identify their business goals and how operations can be realigned to fully leverage the modular model. For example, how is your organization handling call center functionality? What are the key metrics and how do you expect each vendor to participate/support these efforts? Aligning everyone early on the intended outcomes and the path to achieving them is critical to project success.

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