In healthcare, modular, transferrable systems that can be shared among a multitude of agencies are replacing the monolithic, customized IT systems of the past, a panel of state CIOs observed at the State Healthcare IT Connect Summit in Baltimore.
“There’s a shift in IT focus, moving from buildings and architects to the city view, looking at the entire landscape and asking, where do the buildings all fit in our city,” said Ron Baldwin, CIO of the State of Montana and moderate of the keynote panel session.
“The next generation of healthcare systems must leverage a lot of things to be a holistic approach,” he said. “They will be more agile—more iterative and incremental, demonstrating results early and often. The patience and money for taking years to delivery something just isn’t there anymore.”
The three panelists—Mike Wirth, special advisor on eHHR integration for Virginia’s Department of Health and Human Resources, Sean Pearson, deputy cabinet secretary for New Mexico’s Human Services Department, and Chris Clark, executive director of Kentucky’s Office of Administrative and Technology Services—answered a series of questions on the direction of healthcare IT.
Question—How are you leveraging components of integrated eligibility systems?
Pearson—“We just finished a system to integrate other programs and health services. We saw a need to modernize our information systems. Medicaid touches several state agencies and federal partners, as well as providers. There’s a lot of commonality in what we are asking MMIS with what other agencies are asking, such as child support, WIC, child welfare.
Clark—Components were already in place to meet ACA requirements, such as document management repositories, identity and access management. We’re working on a workflow solution that could work for eligibility systems as well as the health exchange. We’re looking at SNAP, WIC, and other programs to be using the same technology.”
Wirth—“A lot of what we’ve done, can go to other secretariats. We’re looking at elections, because it’s good for them to improve voter rolls, or DMV.
QQuestion—How should the next generation of MMIS be built?
Clark—“There is no be-all, end-all solution. We need ability in operations today, to deal with changing business requirements and regulatory changes. Now, we expect real time data exchange, instead of overnight batch jobs.”
Wirth—“We’re about 65 percent managed care in Virginia. Continuing on the ACO model, what will be left in MMIS are the most challenging groups, compound needs individuals. We will need a lot of flexibility to handle groups, like age-blind disabled, the homeless, and veterans. Stable housing may even be part of decision criteria.”
Pearson—“We decided that this is not a pure information technology project. We needed to find services to integrate with our agencies and services, to improve health and services.”
Question—How can IT contain costs, even under Medicaid expansion?
Wirth—“Our previous administration sued the federal government over ACA, but now the new administration came in to expand it. We don’t know if expansion will continue. But moving enterprise services defrays the risk. The more agencies that use your services, the less of an impact any change will have.”
Clark—“Before the ACA, Kentucky had the 10th highest uninsured rate in the country. With the health exchange, 500,000 people enrolled in quality healthcare. We went form 10th highest in uninsured to 11th lowest. With the expansion, we identified over a billion dollars paid to providers, half of that to hospitals. There is a $30 billion economic impact. IT can save costs—the real savings are in health delivery programs, like ACOs, or patient centered medical homes. And there’s a value in a healthy workforce.”
Pearson—“We had 200,000 enrollees in the first year of Medicaid expansion in New Mexico. It caught us off guard. Analytics and big data are important here, so we understand the financial impact of people coming into the extended program.
Question—What were the results of integrated human services and healthcare?
Pearson—“We did the integration all at the same time, phasing in programs across the state, while expanding Medicaid. The big value was getting policymakers to talk about the whole person, and the expansion showed us the impact on other programs in the state.”
Wirth-“When we opened our new portal, we brought everything into that system. We saw opportunities to reach out to other groups, to make this a one-stop shop.”
Clark—“We’re expanding our current system to SNAP, TANF and other programs. We’re looking at correcting some of that history of being at the bottom. Smoking, obesity and diabetes are a key focus. Our providers want actionable data, and proactive applications. We may be able to meet some of those needs with technology.”
Question—What’s been the impact of incremental modernization, versus rip and replace strategies?
Pearson—“Old systems cost $250 million or more. We recognized that MMIS systems take a long time, that states want everything under the sun. But multiyear projects didn’t work for us. We are changing the that systems integration happens in New Mexico.”
Clark—“We started our exchange in October 2013. Now we’re heading down a path of reusing components created from that, as well as taking other components. A lot of systems stay in government longer than we anticipated.”
Wirth—“Modular incremental approaches make sense. But this isn’t something our states have traditionally done. When talking about an agile system, we may be scaring some folks. They’ve been used to doing something the same way for a number of years.”
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