Author Archives: HITC Editor

NewHealth Collaborative is a physician-led accountable care organization that supports its primary care physician members in their transformation to advanced primary care practices.  One effective mechanism that has been employed to improve patient outcomes and decrease cost of care is the integration of care management support services into 100+ primary care sites.  To date, this support team (which is employed centrally but deployed out to local offices) has included a small core of RN care managers, LSW care managers, and health coaches. NewHealth Collaborative is working to identify how it can provide more integrated behavioral health and pharmacist support to primary care settings in which an “embedded” model of deployment is not sustainable. 
 
The IT infrastructure that is being assessed to support a more virtual integration of support services includes (but is not limited to):  data aggregation and analysis programs that provide a more robust mechanism to identify potential patients for proactive outreach, and allows for tracking of patient progress and outcomes over time; technology solutions to facilitate the engagement of specialty support services for the patient and their primary care team, including tele-medicine solutions and asynchronous communication mechanisms; and the use of web-based, patient-directed programs for ongoing monitoring of progress in between conventional office visits.
 
Come join this discussion to share ideas and brainstorm about alternative mechanisms to augment primary care teams across a community with these centralized support services.

Accountable Care Implementation Roundtable Presenter
Nancy Myers, VP of Population Health Strategy, NewHealth Collaborative (Summa Health)

Time: 7:45- 8:30 a.m.
Location: The 2016 Accountable Care & Health IT Strategies Summit,Hyatt Regency Hotel, McCormick Place, Chicago, IL.

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Chicago’s Safety Net. Established in 2014, the Chicago-based MHN ACO, LLC is a provider-owned collaborative comprised of 9 Federally Qualified Health Centers and 3 Hospital Systems and their Physician Practices operating in a unique egalitarian structure where each provider has an equal voice. Under this leadership and in partnership with local not-for-profit Medical Home Network, MHN ACO has implemented a community-based, practice-level model of care.

MHN’s web-based Care Coordination Exchange—MHNConnect—is the anchoring technology platform for the MHN ACO, and also provides connectivity more broadly to the entire CountyCare Health Plan, serving 180,000 Medicaid members. MHNConnect virtually integrates 21 disparate hospitals with more than 155 primary care medical homes; combining historical claims and Rx data, real-time activity alerts, and patient-reported data in an intuitive interface that enables proactive, practice-level care management.

This 2015 Roundtable Session Presentation discussed how to understand, how the MHNConnect platform enables the MHN ACO to achieve its goals of implementing structured, patient-centered care management that improves care, lowers costs, and reduces readmissions.

Presenter:
Laura Merrick, Senior Project Manager, Medical Home Network

To present at the 2016 Accountable Care Implementation Roundtables Please contact:

Victoria Smith, Communications Director,
Healthcare IT Connect
victorias@healthcareitconnect.com

 

 

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With a growth rate of 34 percent a year and an estimated 187 wearable, health-related devices in circulation by 2020, mHealth and wearable health technology are being explored as a significant value add to the doctor-patient relationship. But the technology remains in fledgling stage—fitness and health tracking features are still often clumsy, and lack consistency. Meanwhile, connected medical homes are catching on as effective ways to ease communications between providers and patients, monitor patient medical data (and manage that data in the clinic), and reduce the need for costly office visits. Does this mean that mHealth and Connected Medical Homes could form a perfect union? Or will interest in wearables fade away? Keep up on the latest trends in this valuable session.

Presenters
Steve Milligan, Medical Director of ACO’s at Colorado Health Neighborhoods
James Mault, MD, FACS, Chief Medical Officer and VP, Qualcomm Life
Brandon Tudor, AVP, Access & Administrative Services, MedStar National Rehabilitation Network
Russ Johannesson COO, Sharecare

View this session in HD Video 


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A linchpin of healthcare reform—will require much more than remote measures of health trends.

Now, integrated programs are needed that will improve community health and provide measurable statistical results and reduce healthcare costs. Success will depend on a shift in focus from the clinic to the population at large, and adapting provider practices, data collection and analysis. At this sessios panelists wille explore the integration of clinical, claims as well as external data including socio-economic data, access to critical support services and patient generated data and the ability to analyze this data and to make it actionable across the accountable care enterprise to optimize this new public health environment.

Presented by
Panel Leader/Moderator:
 Creagh Milford, DO, MPH, Associate Medical Director, Partners HealthCare Population Health Management
Nicholas Marko, Chief Data Officer, Geisinger Health System
Morey Menacker, CEO Hackensack Physician Hospital Alliance ACO, Director Population Health Management, Hackensack University Medical Center
Jim Walton, CEO, Genesis Physician Group & Genesis Accountable Physician Network & GenHealth
Mason Beard, Chief Product Officer & Co Founder, Wellcentive

View the HD Video Session Here

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Why do organizations move to the cloud?

Similar to organizations in other sectors, state health IT organizations move to the cloud for a variety of reasons. Many transition to the cloud in support of Cloud First policies that mandate agencies maximize capacity utilization, improve IT flexibility and responsiveness, and reduce cost. While this is the case for some, other organizations move to take advantage of the inherent benefits the cloud offers, such as increased speed and agility, cost savings, on-demand scalability, and the ability to move to a “pay as you go” usage model. For state health organizations, speed and on-demand scalability remain key benefits in supporting a community and user base that surges and spikes based on cyclical healthcare enrollment, submission and payment cycles.

Is the cloud really cheaper and how is operating in the cloud different?

Many organizations experience real cost savings once they’ve moved to the cloud, but need to consider up-front migration costs related to re-architecting applications and standing up new environments. Most organizations realize cost savings only when they successfully move to a “pay for usage” model and scale their cloud infrastructure up and down in real time to meet demand, such as during annual health plan eligibility enrollment or healthcare related reporting or reimbursement submission periods. Because cloud resources can be provisioned and de-provisioned on demand and in real time, IT environments can be right-sized to reflect true operating costs, versus idling or “going dark” when the infrastructure isn’t used to its full capacity. This is one of biggest differences between working in a traditional data center and working in a cloud environment – the ability to access resources in real time and only pay for resources when they are required.

What are some hindrances in moving to the cloud?

So why do state health organizations resist moving to the cloud? The reasons aren’t so different from other industries: fear of change, security concerns and a perceived lack of control. However, once organizations begin operating in the cloud and become comfortable with a new governance and operating model, they quickly see the benefits and associated cost efficiencies.

Conclusion

Not only can operating in the cloud be more cost-effective, it fundamentally changes the buying habits of state health organizations. By moving away from buying large hardware platforms to buying “cloud services,” state health organizations make the fundamental shift from focusing on large hardware purchases and worrying about annual tech refreshes, to focusing on essential health services and IT governance. Since the cloud provides better visibility into IT capacity and usage, it helps organizations provision resources more dynamically.  What could take months in a traditional data center, now takes minutes. With access to real time data, minimized costs and increased agility, state health organizations can provide better, timelier services to their health customers.

This article was contributed by Scott Rutler, Senior Director, General Dynamics Health Solutions. General Dynamics Health Solutions also presented at the 2016 State Healthcare IT Connect Summit on the topic of Protecting the State of  Your Program Integrity Initaitives

Contact General Dynamics Health Solutions at info@gdhealth.com to learn how we can help guide your organization to the optimal cloud solution for your unique mission and budget.

Subscribe to View the HD Video Presentation | 

Presenters
Jala Attia, Sr. Program Director, Program Integrity Solutions, General Dynamics Health Solutions
Stephen A. Smith, MBA, Senior Director, General Dynamics Health Solutions

To learn more about opportunities to participate at the 2017 State HIT Connect Summit, please email Victoria Smith, Communications Director, Healthcare IT Connect  victorias@healthcareitconnect.com

 

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MACRA, MIPS & Framing the Opportunities for HIT

CMS aims to tie 30 percent of payments to value through alternative payment models by the end of this year. By 2018, CMS plans to boost that figure to 50 percent.

The healthcare payment reform movement has brought both advantages and challenges to the industry. Of course, pay-for-value models give patients the benefit of efficient and quality care. Meanwhile, medical facilities must adapt to compensation changes, which require adjustments of healthcare information technology systems.

Rob Anthony, Acting Group Director of the Quality Measurement, Value Based Incentive Group, CMS and Kelly Cronin, Director Office of Care Transformation, ONC/HHS recently presented a keynote at the 2016 State HIT Connect Summit in Baltimore to introduce the MACRA and MIPS frameworks and how these will shape opportunities for HIT.

Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)

Rob Anthony, acting group director of the quality measurement incentive value group of CMS, noted that quality has become a focal point in healthcare in the last decade, partially due to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). The legislation, which replaced the Sustainable Growth Rate formula and serves as the new model for establishing Medicare payments for healthcare services, allows physicians to demonstrate payment value. MACRA also works to reduce the burden of reporting by consolidating existing programs into a single system, according to Anthony. MACRA achieves this through two key pathways: merit-based incentive payment systems and APMs.
“There is an ‘overriding principle of minimizing the reporting burden.’”

Merit-based incentive payment systems

As Anthony explained, MIPS has three main goals: to provide better care, utilize smarter spending and achieve better health outcomes. Incentives will help accomplish these benchmarks, such as value-based payment, reformed care delivery and information sharing across multiple settings through strategies like care coordinating.

To be sure, CMS recognizes that there is no one-size-fits-all solution, and that’s why the organization offers multiple pathways with varying levels of risk and reward for providers to achieve the goal of tying more payments to value. However, Anthony noted that there is one overarching principle that just about every medical facility can relate to.

There is an “overriding principle of minimizing the reporting burden,” Anthony said at the summit.

He explained that he often hears physicians complain that they report the exact same data to several different places. The CMS hopes to target this pain point so that participation in and of itself does not become a burden and the healthcare industry can reach those main payment reform goals.

How does the CMS plan to mitigate reporting barriers? The MIPS combine several systems, including the physician quality reporting program, value-based payment modifier, and the medical electronic health record incentive program. This streamlined method means physicians don’t have to enter data into multiple platforms.

Alternative Payment Models

APMs, such as patient-centered medical homes, accountable care organizations and bundled payment models, are another path for physician compensation. As an incentive to adopt this method, the CMS offers physicians a 5 percent lump sum bonus on top of the rewards reaped from MIPS adjustments.

Making Connectivity a Priority

This payment shift requires states to think about steps they must take to drive the adoption of these new models. For example, what services do states require? What capabilities do they need? Answering these questions will help the regions facilitate proper data management.

Standardized, structured and actionable data that reflects shared expectations from all stakeholders is key to interoperability. Overall, this can paint a more accurate picture of the individual and patient population, and thus fuel better health outcomes

Subscribe to View the HD Video & PP of the Presentation | Health Care Payment Reform: New Policies Framing the Opportunities for HIT

To learn more about opportunities to participate at the 2017 (8th Annual) State HIT Connect Summit, March 28-29 in Baltimore please email Victoria Smith, Communications Director, Healthcare IT Connect victorias@healthcareitconnect.com.

Join 300+ Clinical, Business and IT leaders at the 2016 Accountable Care & HIT Strategies Summit, Sep 8-9 in Chicago – email robw@healthcareitconnect.com to lean more about sponsorship opportunities.

Subscribe to View the HD Video Presentation | Health Care Payment Reform: New Policies Framing the Opportunities for HIT

Presenters
• Rob Anthony, Acting Group Director of the Quality Measurement, Value-Based Incentives Group, CMS
• Kelly Cronin, Health Reform Coordinator, ONC/HHS

To learn more about opportunities to participate at the 2017 State HIT Connect Summit, please email Victoria Smith, Communications Director, Healthcare IT Connect  victorias@healthcareitconnect.com

Sources:

2016 State Healthcare IT Connect Summit

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html

http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page

http://www.brookings.edu/blogs/health360/posts/2014/07/23-alternative-health-care-payment-model-beginner-guide

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Patients want the simplest approach when it comes to receiving quality care. The integration of accountable care organizations aims to meet that demand for easy, simplicity and quality, but experts agree ACOs still need work. Sure, the ACO method, which involves groups of providers collaborating on patient well-being, provides a paved pathway to care for patients, but it still often leaves providers, health plans and other healthcare constituents wandering around in this vast, chaotic landscape.

If there’s anyone who can provide clarity on the subject, it’s David DiGirolamo, the vice president of Health Information Technology and Informatics, Partners in Care Corp., DiGirolamo has experience in both healthcare business and information technology, giving him unique insight into the demands being placed on an ACO and the capabilities of the solution provider segment to support their requirements. He recently spoke at 2015 Accountable Care & HIT Strategies Summit specifically on this topic, providing the audience with realistic expectations, best practices and tools for selecting an ACO platform (you can view the session in HD video at the ACO HIT Connect Media Portal).

Defining ACOs

According to Kaiser Health News, healthcare stakeholders like doctors, providers and hospitals voluntarily form groups, known as ACOs, to coordinate and provide high-quality patient care. By entering ACOs, these constituents may receive bonuses and share the savings they achieve by containing costs.

DiGirolamo says ACOs perform both care coordination and population health management, though these definitions differ based on who you talk to. According to DiGirolamo, this diversity is only natural based on varying ACO stakeholders and locations. In general, though, the distinction between care coordination and population health management boils down to the number of patients.

“We basically look at it as care coordination is the one patient at a time part of it, and population health management is when you roll it up into larger groups,” DiGirolamo said. “Bouncing back and forth between macro and micro is what an ACO does.”

A complex picture
Cost containment is just as an integral component to ACOs as quality. However, measuring saving, in terms of finances and time, identifying areas for improvement and then executing advancement strategies can be quite the challenge. As Health Catalyst explained, ACO leaders must consider organizational aspects like governance and board structure and analytics. They must also evaluate financial components, such as predicting costs association with population health management. ACO platforms were created to manage these complexities, though they add an additional element of confusion. Leaders often ask: Which vendor is right for my ACO?

The growing ACO IT marketplace 
Platforms are continually popping up to answer that question, as the number of ACOs and health IT in general grow. As DiGirolamo explained, for 2012, global healthcare is growing at a rate of 14.2 percent compound annual growth. North America, specifically, is growing at a rate of 7.4 percent.

“There’s a lot of pent up investment money, and there’s a lot of money being spent in the marketplace,” he explained. “So what you’re seeing is tons of vendors coming from all over the place just springing up and looking to grab a piece of the pie.”

Watch out for common myths
DiGirolamo stressed the importance of not believe everything you hear about what constitutes a quality ACO platform vendor.

Vendors know it all. Many purchasers find platforms and falsely believe the vendors have access to all necessary information. Clients must go into agreements with a healthy level of skepticism, especially as it applies to risk management, as many vendors don’t have this type of expertise.

Long track records in health IT mean more mature products. Time isn’t the answer to everything. Many vendors have acquired products that have merely been adjusted and repurposed to meet changing needs. In fact, the companies may have had an entirely different business model at the start, which means their projects are really just as new as up-and-coming businesses. Instead of considering only how many years a vendor has been around, look at why it entered the market in the first place. Your best bet is with a vendor who set out to build a population health management system from the get go.

Blue chip vendors have more resources and deeper expertise. In DiGirolamo’s experience, he’s found that expertise is even across the board. In fact, smaller companies often have more people who have gotten their hands dirty and gained knowledge through experience.

Between the growing health IT industry and the budding ACO platforms, it is vital for ACO leaders to implement an effective selection process. During his presentation, DiGirolamo gave guidance on this endeavor.

What Makes an Effective ACO Platform

There are many components that go into a successful ACO platform. These solutions must allow for more than just the exchange of data. There must also be a heavy analytics component that makes data actionable. ACO leaders should be able to use that information to make practices more efficient at the clinical level and improve care quality, which may require making data exchange a workflow component for providers.

“We can’t just come down from on high and just push procedures down,” DiGirolamo explained. “You inhibit people’s creativity. To some degree you need standards, but you need to rely on the talent of the clinical teams.”

DiGirolamo also stressed that the platform must support resource allocation. It should not only show how many patients are in a full population and how many clinicians. A platform should also allow ACOs to assign patients on whatever basis the ACO stakeholders choose. Moreover, there must be an acuity element that puts certain patients higher up on that assignment list.

DiGirolamo also highlighted what he calls proscriptive analytics. If ACO stakeholders realize they must improve in certain measurements, the platform should be able to come back says what they need to do to meet those goals.

To be sure, some of these ideas are still up and coming, as some ACO platforms have yet to adopt these strategies. However, they showcase necessary adjustments for the future of ACO platforms.

Selection process best practices
Finding an effective ACO platform is only one part of the equation. Purchasers must also ensure the vendor will be a prosperous partner. DiGirolamo advised ACOs leaders narrow their vendor list down to no more than 20 vendors before diving into this process.

Evaluate their website. It seems simple enough, but a website says a lot about a company. If the vendor doesn’t provide enough details on its website, investigate the reason for these information gaps when speaking with the sales department.

Request demos. ACO leaders should ask for these demonstrations before issuing their request for proposal to save time. While one to two hour-long web-based demos are a great starting point to narrow down options, DiGirolamo said these must be followed up with in-person walkthroughs as well, perhaps four or more meetings after issuing RFPs. Decision makers should be present by that final on-site demonstration for the top four or five vendors, as these executives can evaluate both the product and the vendor workplace. Executives should also take this opportunity to engage the vendor employees to see if they are passionate about producing quality work.

Align scoring with the RFP. ACO leaders can’t expect vendors to do well on scoring if the evaluation criteria aren’t listed in the RFP. This ensures all stakeholders are on the same page.

Research the company. Purchasers can never know too much about a vendor, and DiGirolamo does his due diligence whenever he’s evaluating a company. Scrutinize the vendor employees’ LinkedIn pages, request a list of all their clients within the last six months and follow up with those organizations.

The Final Evaluation

When ACO leaders have found the ideal vendor, they must review the platform in practice. What truly matters is how it functions on a day-to-day level. If there is too much overhead for clinicians or the platform is not yielding the intended results, ACO leaders must find a different solution. As with many components of healthcare, finding the perfect platform may take a trial-and-error approach.

David will be providing additional insights on the alignment of the vendor marketplace offerings to ACO market requirements at the 2016 Accountable Care & HIT Strategies Summit, September 8-9 at the Hyatt Regency McCormick Place, Chicago. Please email robw@healthcareitconnect.com to discuss speaking opportunities or to receive information regarding participation as a sponsor.

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Data analytics play an integral role in population health management. Experts cannot begin to address the well-being of a region’s residents without understanding the components that go into their overall health. Many healthcare industry leaders aim to put data analytics at the forefront of innovation, including the panel of experts that discussed this topic at the 2016 State Healthcare IT Connect Summit. Coming from varying sectors, the presenters emphasized the importance of stakeholders working together to achieve change in the healthcare industry that ultimately leads to cost efficiency and quality care.

A relatable analogy
Launching the discussion with a creative spark, moderator Jeremy Racine, director at SAS Government Healthcare, likened industry leaders to general contractors. Racine explained that their innovation efforts, such as mobile applications and electronic media records, are like houses. He posed the question: Are these leaders applying standards when building the houses? Buildings need electricity, plumbing and other infrastructure to have a solid foundation.

Similarly, industry leaders must have a firm base of standards and analytics when developing tools for reshaping the industry, which involves commitment from both the private and public sectors. Racine explained that there are many amazing houses – or healthcare innovations – across the U.S., but they lack connecting factors. The health information technology industry must work to link these platforms with good, clear data.

“Bad data means bad decisions,” Racine warned. That solid foundation of data and analytics is necessary to progress in innovation, healthcare payment reform and enhanced care quality.

During the question and answer session, Racine detailed this analogy further, explaining that data analytics are also like the windows of a home. They allow stakeholders to view trends and see results.

The importance of connectivity
Kate Kiefert, special advisor of the Office of the National Coordinator for Health Information Technology, agreed with Racine’s comparison of a house’s foundation to healthcare innovation data standards. However, Kiefert took it one step further, emphasizing the responsibility of stakeholders to collaborate.

She explained that general contractors wouldn’t build a water sanitization system for every single house. Similarly, health IT innovations should not always use separate infrastructure. She stressed that without underlying health IT used for exchanging, capturing, measuring and analyzing information, organizations will never understand where they can improve population health and reduce spending costs.

Patrick Roohan, director of the New York State Department of Health, expanded on the idea of collaboration, citing the importance of alignment for improving care quality, population health and cost reduction. States must prioritize alignment, particularly with policy direction and Medicaid. Additionally, states should find an effective analytical quality measurement process to get to the root of quality improvement.

Further innovations
Jason Buckner, the senior vice president of informatics at The Health Collaborative, expressed that it’s not enough just to identify problems. States must also come up with solutions, and he brought four possibilities to the table.

  • Agree upon what to measure: According to Buckner, this is a “painful problem for all of us,” and states must come to an agreed-upon conclusion.
  • Open source the math: As the logical progression from the above point, Buckner stressed that states must also concur on a means of measurement. This will ultimately answer the questions: What’s the attribution logic that’s being used? What goes into calculating data? Truly, it’s a vendor-specific issue, but the U.S. Centers for Medicare & Medicaid Services have the potential to lead this type of effort, which would ultimately bring about a reduction of computing costs.
  • Reduce the data touch points: Providers are faced with the burden of reporting, as they must send data to several different places. Buckner proposed a regional data intermediary approach in which providers would send data once to a single organization. Then, someone else figures out how to get the data everywhere else it needs to go.
  • Operate regionally: Buckner explained there are national, state and even regional initiatives that all hold importance. However, healthcare gets truly transformed when it functions in a local environment, so changes must happen at the local level.

The right attitude matters
Arvinder Singh, the chief health innovation officer at CNSI, expressed that these innovations certainly pave the way to a bright future for data analytics and population health management. However, the healthcare industry must embrace the idea that having the right mentality sets the stage for better outcomes.

Singh explained that he has worked with Medicaid for 15 years but still considers himself a rookie. This mindset allows him to learn new things about what’s happening in the industry and fosters innovation. He warned that the minute industry leaders consider themselves experts is when they’ll stop innovating. The industry must strive to identify new areas for improvement and come up with solutions. What’s more, stakeholders must accept the fact that healthcare is uncertain, and there’s no way to create a product or solution that will serve the same purpose years down the road. IT systems and architecture have to evolve.

Along with that attitude, industry leaders must make privacy a priority. He noted that experts like those speaking on the panel are “guardians of the most vulnerable population.” They make privacy fundamental to the data processing pipeline.

Patient engagement
Similar to Singh’s encouragement for respecting patient privacy, Eric Olofson, chief operating officer and chief information officer at Citra Health, also aims to put focus on the patient. He wants a product that enhances the patient-provider encounter and encourages the consumer to come back, leading to quality results and cost reduction. Olofson also noted having open platforms that allow the sharing of de-identified data would simplify everyone’s job.

Kiefert weighed in on this perspective during the question and answer session, noting that what industry leaders see as important may not be so critical to patients, the ones who truly matter. She said that there’s a “communication desert” between the healthcare industry and the consumer. Patients don’t realize they can advance change by making their voices heard.

While each panel member brought a different perspective to the conversation, the general consensus is that collaboration and a firm foundation are key to innovation, and leaders must consider the patient’s mindset, too.


Subscribe to View the HD Video Presentation |  State Innovation, Data Analytics and Population Health Management

Moderator: Jeremy Racine, Director, SAS Government Healthcare
Arvinder Singh, Chief Health Innovation Officer, CNSI
Kate Kiefert, Special Advisor, ONC
Jason Buckner, SVP Informatics, The Health Collaborative
Eric Olofson, COO & CIO, Citra Health
Patrick Roohan, Director, Office of Quality and Patient Safety at NY State Department of Health

To learn more about opportunities to participate at the 2017 State HIT Connect Summit, please email Victoria Smith, Communications Director, Healthcare IT Connect  victorias@healthcareitconnect.com.

Sources:

2016 State Healthcare IT Connect Summit

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447747/

 

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As more states join in expanding modularity, the health information technology community is trying to bring in more tech companies and vendors to identify entrance barriers. Members of what was dubbed the “Jedi panel,” taking on a “Star Wars” theme, discussed key points regarding stakeholder participation in modular MMIS modernization and health and human services ecosystem. Here’s what the experts had to say at the 2016 State Healthcare IT Connect Summit:

Developing an understanding
A major component of stakeholder participation is clarifying each state’s understanding of modularity. According to Kay Hallawell, the senior solution director at Optum Government Solutions, with Medicaid, there’s no one-size-fits-all package for states. These regions need to understand how their modules work to determine what they need. Pradeep Goel, chief executive officer of EngagePoint, said that a consistent definition helps states avoid a guessing game.

Defining modularity
Jessica Kahn, director of the data and systems group of the U.S. Centers for Medicare & Medicaid Services, emphasized that the CMS released a final rule outlining the specifics of modularity. The regulatory definition of modularity is the grouping of live business processes. This minimizes the impact from changes to individual units.

Goel discussed how boundaries are an integral component of modules. He encouraged the audience to think of modules as functional encapsulations driven by business needs. Modular formatting is necessary to upgrade or replace the different facets without impacting adjacent modules. To do this, they need well-defined boundaries.

State flexibility
While modules have certain necessary components, there is still room for flexibility on a state-by-state basis, Kahn explained. There are three main options when it comes to how states group processes.

• Grouping as traditionally done in MMIS.
• Maps to Medicaid Information Technology Architecture.
• The state’s own choice.

Furthermore, Kahn noted that the CMS is not defining modularity for the state but rather the modules’ functionality. The definition is there to support business processes.

What is consistent across the board, though, is certification criteria that support each business process. The underlying functions of each module are going to be the same. This balance allows vendors to practice innovation and states to be both consistent and flexible.

System integration
Panel members expressed that the system integrator must be present at the beginning of the process to identify potential risk and pitfalls. Kahn likened this component of health IT to the overarching metaphor of building a house. A general contractor wouldn’t put up walls before calling in an electrician. Similarly, a state shouldn’t develop solutions without a system integrator’s input.

As another first step, businesses must establish their needs before turning to technology solutions. Otherwise, there’s no telling if the innovation will actually serve a meaningful purpose.

Subscribe to View the HD Video Presentation |  The Force Awakens: Accelerating Stakeholder Participation in the Modular MMIS HHS Ecosystem

Moderator: 
Robin Chacon, Healthcare & Human Services Practice Director, CSG Government Solutions
Ron Baldwin, CIO, State of Montana
Jessica Kahn, Director Data & Systems Group, Center for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services
Kay Hallawell, Sr. Solution Director, Optum Government Solutions
Chris Lunt, VP Engineering, GetInsured
Pradeep Goel, CEO, EngagePoint
Chris Greene, Associate Vice President, Business Architecture, Molina Medicaid Solutions, Molina

To learn more about opportunities to participate at the 2017 State HIT Connect Summit, please email Victoria Smith, Communications Director, Healthcare IT Connect  victorias@healthcareitconnect.com

Sources:
2016 State Healthcare IT Connect Summit

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/mmis.html

http://searchenterpriselinux.techtarget.com/definition/COTS-MOTS-GOTS-and-NOTS

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Optum’s Steve Larsen shared his insights on the impact of modularity on MMIS procurement and H&HS transformation.


Rob Waters:
Why is modularity a positive for states?

Steve Larsen:The modularity standard has existed for quite some time as part of MITA. However, the final rule for Mechanized Claims Processing and Information Retrieval Systems (12-2015) is driving increased emphasis and new requirements for states to modularize MMIS procurements. This approach provides several benefits for states:
• Cuts the risk of time and cost overruns and accelerate the implementation of certain capabilities. Modularity also allows for easier upgrades or complete replacement as technologies evolve and program needs change.
• Opens up the Medicaid market to new vendors and increased competition. This can help inject new ideas to drive significant innovation and cost reduction.
• The opportunity to establish capabilities that are needed across the state enterprise, while leveraging a shared funding model.
• Maximum flexibility in deciding the modularity strategy that will work best for their state and their program.

States must balance these benefits of the modular approach with the complexity associated with “too many” modules. In the absence of CMS standards, it may take time for the market to determine the optimal number of modules that will allow for states to easily compare vendor offerings. But if CMS moves forward with a pre-certification process, that will help with standardization and make the market more competitive to the benefit of states.

RW: How do you know if you’re modular?

SLSo far it appears CMS has supported different forms of modularity, some with many modules and some with just a few modules. However, a state’s use of modularity must meet key criteria, including

1. Create downstream flexibility in the event the program substantially changes,

2. Lower implementation risk by cutting big-bang implementations into manageable pieces,

3. Define APIs and architectural standards to allow for interoperability with other modules,
and

4. Leverage market capabilities that already exist.


CMS has shown flexibility in how they deem a state “sufficiently modular” with their MMIS system. By meeting the criteria above, CMS may view a state as “sufficiently modular.”

RW: What are the IT and business implications of modularity for states?

This is an interesting question and really gets at the core of the modularity debate.

There’s a school of thought that interprets modularity as a “system” feature, meaning, modularity is the degree to which a system’s components may be separated and recombined. But using the definition from the final rule, we see that the notion of “business process” as an integral part of how CMS views modularity. In the final rule, a module is defined as “a packaged, functional business process or set of processes implemented through software, data and interoperable interfaces that are enabled through design principles in which functions of a complex system are partitioned into discrete, scalable, reusable components.” So, a module may meet the CMS definition by being either a “packaged” interchangeable “system” component or a “packaged” interchangeable business process (or set of processes) component. In the latter, CMS opens the door to “business services” as eligible for consideration as modules in addition to system components.

That’s why we see widely varying interpretations among states. We have heard some states are planning as many as nine modules and others planning for just four. The more a state interprets modularity as a system feature, the more modules a state will likely acquire and the greater the need for a systems integrator to tie them all together.

The more a state interprets modularity as a business service component, the fewer modules a state will likely require and the less the need for a systems integrator since the modules have been pre-tied by the services provider. In this case, the systems integrator need only manage handoffs between the services modules and the interfaces to state systems. Another important point for states to consider is that in the “system” interpretation, the state is more likely to tailor the system to existing state business processes, whereas in the “business service” interpretation, the state will more likely need to adapt its business processes to accommodate the services model provided by its vendors. This requires greater state flexibility to modernize its business to adopt commercial best-practices brought by its vendors.

RW: What are additional criteria to keep in mind when determining how to modularize for procurements?

To build on the comments in question two above, I suggest three additional criteria for states to consider:

1. Maintaining accountability: States will need to establish a clear accountability model. States may not necessarily have “one throat to choke.” They will have to think carefully about how to structure service level agreements, interoperability standards and performance measures for the various contractors. It will also require new skillsets from the state teams, most notably, vendor management experience.

2. Cutting risk: The more a state can align its needs around capabilities that already exist in the marketplace, the more a state drives up competition for its business and drives down risk. We call this alignment “commercial modularity.” It takes advantage of the way the market already works, as opposed to forcing the market to transform itself to adapt to how a single state would want it to work. It requires states to be flexible, but will greatly reduce risk.

3. Team capacity and capabilities: All states have made investments in a system. But that doesn’t mean states have to remain tied to updating and maintaining the system through modularity. There are a variety of options – from system to services and to hybrid approaches – that will integrate with existing or new investments. States need to honestly assess their capabilities and decide if they have the capacity to manage a system, multiple procurements, and extensive system integration to build and run a modular system. If a state doesn’t have the capabilities or if the goal is to achieve specific business objectives, a services-based approach is a viable and effective option. Depending on how the business objectives are defined, there could be fewer procurements, less integration, and less management of a system, allowing the state to focus all their resources on meeting their business objectives.

Optum are a Platinum Sponsor at the 2016 State Healthcare IT Connect Summit.

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Keynote Panel: Delivering Integrated H&HS: Interoperability, Data & the Enterprise Approach

Moderator:Scott Dunn, Director of H&HS Solutions, Optum
Jessica Kahn, Director Data & Systems Group, CMCS, CMS
Chris Underwood, Director, Health Information Office, Colorado DHCPF
Tracey Wareing Evans, Executive Director, APHSA
Adam Dondro, Assistant Director – Horizontal Integration, California DSS
David Whitham, Assistant ACIO, Health & Eligibility, Massachusetts EOHH

Monday March 21st, Day 01  2016 State Healthcare IT Connect Summit, Baltimore, MD.

Track 1
‘The Force Awakens’: Accelerating Industry Participation in the Modular MMIS, H&HS Ecosystem

Moderator: Robin Chacon, Healthcare & Human Services Practice Director, CSG Government Solutions
Ron Baldwin, CIO, State of Montana
Jessica Kahn, Director Data & Systems Group, Center for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services
Kay Hallawell, Sr. Solution Director, Optum Government Solutions
Chris Lunt, VP Engineering, GetInsured
Pradeep Goel, CEO, EngagePoint
Chris Greene, Associate Vice President, Business Architecture, Molina Medicaid Solutions, Molina

Tuesday March 22nd, Day 02  2016 State Healthcare IT Connect Summit, Baltimore, MD.

Optum are also the 2016 State Healthcare IT Connect Media Portal Sponsor

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