Author Archives: HITC Editor

Editor’s Note: John Selig is senior vice president at the Lewin Group, a national health and human services consulting firm owned by Optum.  He was previously the director of the Arkansas Department of Human Services, where he led several public health, human services, and technology initiatives.  A former Peace Corps volunteer, he is a frequent presenter at national forums on topics that include Medicaid, Social Determinants of Health, behavioral health, and payment reform.

John Selig, Senior Vice President, Lewin Group, sat down with Healthcare IT Connect’s Rob Waters to discuss the potential impacts of SDoH (Social Determinants of Health) data and how Medicaid is well positioned as a nationwide platform to utilize this data to better coordinate health, social programs, and community resources to improve outcomes.

Join John Selig on: Thursday, April 5  | 2:45pm – 3:45 p.m.  Track 2: Measuring and Managing the Social Determinants of Health

Rob Waters. First, can you explain what is meant by Social Determinants of Health (SDOH) and why they’re important to overall health outcomes?

John Selig:  Mounting evidence shows that socioeconomic factors – education level, access to nutritious food, physical safety, living environment, employment, and housing stability – affect well-being and may have a greater impact on a person’s overall health than health care services themselves.  Collectively, these factors are referred to as Social Determinants of Health and they are fast becoming an area of focus, especially when it comes to how once traditional “health care” dollars are spent.  The point is that health care alone can only go so far to improve health; how and where people live may be more important in determining overall health and longevity – your zip code may be more important to your overall health than access to traditional health care services.

RW. What evidence can you cite for this school of thought?

John Selig:  In their book, The American Healthcare Paradox: Why Spending More is Getting us Less, Yale researchers Elizabeth H. Bradley and Lauren Taylor posit the argument – based on comparative health data from 30 countries – that investing in social services directly correlates with a country’s overall health.  They point out that despite leading the world in per capita spending on traditional health care, the United States ranks near the bottom in many health outcomes; one reason why may be that the U.S. spends comparatively little on social services.  Moreover, they subsequently found the same holds true with U.S. states – those states with higher “social-to-health care” spending ratios generally have better health outcomes.

RW. Are there examples from states in which SDOH are part of the overall emphasis on better health?

John Selig: There are many, but I’ll cite two: one rural and one urban example.  In rural Kentucky, a diabetes coalition consults with area food banks and pantries to help them create “diabetes-friendly” food sections, and trains volunteers on healthier choices for people with diabetes – for example, green beans are preferable to corn.  And my “big city” example: New York’s Medicaid program invested in supportive housing for more than 11,000 of its highest cost and highest need beneficiaries – many of whom are homeless.  An evaluation by the State University of New York Research Foundation found that in the 12 months after these recipients were housed, the Medicaid program saw a 40 percent reduction in their in-patient hospital stays and a 26 percent reduction in their emergency department visits.

RW. How does this kind of investment in SDOH affect overall costs to a state?

John Selig: It may reduce costs in the long run, or allow public funds to be re-directed to other priorities.     And just think of the social supports you can afford when you cut unnecessary health costs. Depending on geographic region, one emergency department visit can be equivalent to a single month’s rent; two hospitalizations could equal one year of child care; and 20 MRIs could pay the salary of a social worker for a year – all “social” expenditures that can improve overall health.

RW. Does Medicaid play a key role in focusing on SDOH for better outcomes?

John Selig:  Definitely. The entire health system has a role in connecting with social programs, but Medicaid is well positioned to serve as a primary integrator.  Because Medicaid operates in all 50 states, it offers a common foundation on which to build these connections.  Also, as a federal and state partnership, Medicaid can be tailored to local populations while serving as the link to related social programs – and, targeted use of Medicaid funds on other social programs could eventually reduce overall Medicaid costs. Finally, Medicaid professionals have experience serving lower-income, resource-poor and often chronically ill populations with complex needs – individuals and families who would likely benefit most from a greater emphasis on social determinants to improve health.

RW. What kind of role does technology play in being able to link social programs with improved health outcomes?

John Selig: At the heart of developing an effective “culture of health” across health and other social programs is a state’s willingness to invest in technology that enables experts to see the links between those programs – and allows beneficiaries to more easily access the right supports at the right time. It’s important to identify the most pressing needs, get effective services to those who need them, and analyze and track results to know what’s working. For example, web-based, consumer-facing integrated eligibility systems allow individuals and families to simultaneously apply for Medicaid and other public health benefits, along with programs that administer food and cash assistance, child care assistance, and other supportive services. Strong data systems and analytics also provide states with capabilities to measure improvements and success.

RW. Any final thought on the benefits of focusing on SDOH to improve health?

John Selig:  Health care and social services systems need each other – to serve their communities as fully as possible, to contain costs, and to improve health outcomes.  We have a nationwide health care platform – Medicaid – on which states could build collaboration between agencies that provide traditional “health” services and those that offer other social services.  And we have the technology and analytical capabilities to link, monitor, and assess programs and outcomes.

Focusing on Social Determinants of Health is still a relatively new field, and work still needs to be done to explore which “social investments” will deliver the highest returns.  But it’s clear that investing in programs beyond traditional health care holds great promise to improve near and long-term health outcomes across the board and across the country.

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Brian Erdahl, Deloitte Consulting Principal and State Health Solution Architect, sat down with Healthcare IT Connect’s Rob Waters to discuss how evolving technologies support state programs and promote a connected healthcare ecosystem.

Rob Waters: With organizations focusing on pay-for-performance and health care outcomes, what techniques and technologies can be used to enable these changes?

Brian Erdahl: As organizations continue the migration towards a value-based care world, information architecture takes on a critical role to support the need for enhanced financial and healthcare quality analytics.  In the legacy world, this data typically has been locked in process-oriented systems.  With modularity, data may reside in disparate modules requiring data warehouse technologies to pull the dispersed information together for users.  Beyond this, the information architecture needs the capability to deliver real-time analytics to support workers in their day-to-day work and decision-making.  In addition, the information architecture should define and implement standards, tools, and enforceable service-level agreements (SLAs) to confirm data quality.

RW: In what ways do you envision the emerging “modular health ecosystem” helping states to enable a more connected multi-stakeholder environment?

BE: First, a modular approach allows states to capitalize on existing standards (e.g., X12, HL7, NIST, etc.) within their own ecosystems to move towards the standardized, interoperable environment envisioned by the Medicaid Information Technology Architecture (MITA).  This state modularization and associated standardization unlocks a world of connections with the broader health ecosystem.  The technologies deployed within states open up the ability to connect to a wide variety of information sources, including devices that monitor health readings, health information exchanges, longitudinal member health histories, and more.  Using the current technologies in a secure and open manner has the potential to share information like never before.  In turn, this can provide healthcare providers with appropriate access to information to help make critical healthcare decisions. 

RW: As states look to integrate the modular health ecosystem, how do you see the role of traditional systems integrators (SIs) evolving?

BE: Initially, we are seeing the systems integrator’s role being twofold – first being responsible for implementing an integration platform and an associated set of technologies and then working with other module vendors to implement information sharing through real-time services or traditional batch processes.  Over time, this role evolves to supporting and streamlining state health programs along the lines of MITA’s three architectures – business process, information, and technology.  In this role, the systems integrator helps streamline business processes and implements shared services to support cross-module functions. 

RW: With the shift to cloud-based Platform-as-a-Service (PaaS) implementations, what are the implications for a state procuring these services? 

BE: Systems integrators are providing the platforms to integrate disparate modules.  A PaaS model is well-suited for providing the standardized services required to integrate and share information since, by its nature, a PaaS model is based upon standards and reuse.  Likewise, PaaS supports integration across on-premise modules or other cloud-based modules in a secure and efficient manner.  A PaaS model can be an effective approach for states, but there are some important items to keep in mind during procurement.  For example, states should focus on SLAs and less on prescriptive tools, products, or architectures.  Another step is to define key compliance attributes like security standards, regulations, and standardized Application Program Interfaces (APIs).

Join Brian Erdahl on: Thursday, April 5 • 2:45pm – 3:45pm Track 1: Connecting People to an Informed Health Ecosystem | 2018 State Healthcare IT Connect Summit


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Tracy Waring Evans, Executive Director, APHSA sat down with HITC’s Rob Waters to discuss some of the opportunities and challenges H&HS agencies are facing in designing service delivery frameworks that maximize the opportunity provided by integrated data (including SDoH) and leverage community-based organizations.

Rob Waters: For this year’s plenary panel, APHSA has brought together a cross-section of state, local and provider level presenters. What did you learn during your conversations with panelists regarding “Designing for Impact in Integrated Service Delivery”?

Tracy Waring Evans: Health and human services systems, on the state, local and community levels, are embracing outcome-focused services informed by population-based data, whole family approaches, and advances in brain and behavioral sciences. The H/HS system is experiencing a shift from a reactive, crisis-oriented services delivery model to one that focuses “upstream” and better enables all of us to live to our full potential and to more effectively identify and address root causes when we do encounter roadblocks along the way. Integrated Service Delivery is a key aspect of this shift as it connects previously siloed programs, helps provide access to the right services at the right time, and enables learning environments that better inform us about what works to prevent the need for deeper-end services.

Technology is an important enabling factor in this effort. Many agencies are in the process of transitioning from legacy IT systems that “siloed” customer data to integrated systems that allow front-line workers to see a holistic picture of their clients and tailor services to best meet customer needs. The embrace of technology is occurring at all levels of H/HS, and that is why it is important to hear the perspectives from practitioners on the ground who are leading state and local efforts as well as those leading research efforts. Each brings a distinct perspective and helps paint a picture of the overall H/HS system of today, and what we hope to achieve in the future.

RW: There is a big focus at the moment on SDoH (Social Determinants of Health) and leveraging CBOs (Community Based Organizations) for population health/well-being outcomes, what are some of the challenges for agencies in further leveraging these resources?

TWE: We recently partnered with the Alliance for Strong Families and Communities, SeaChange Capital Partners, and Oliver Wyman on a report: A National Imperative: Joining Forces to Strengthen Human Services in America which focuses on the economic and social impact of human services community-based organizations (CBOs), and the need to strengthen and preserve their pivotal role in the larger human services ecosystem. One of the most important conclusions in the report is that CBOs play a critical role in augmenting state and local H/HS service delivery, but the overall financial health of the nation’s CBOs is not as strong as it should be and the risk of losing services delivered by CBOs is significant.

CBOs are at the forefront of service delivery just as front-line H/HS agency workers are. The direct contact they have with the clients they serve is invaluable in uncovering the SDoH factors that act as roadblocks to individuals, families and communities in reaching their full potential. One of the challenges related to the financial health of the CBO sector is that it is often under-resourced for critical IT upgrades or excluded from interoperability efforts. It is extremely important that all sectors of H/HS work together to ensure that CBOs are also able to maximize data to effectively deliver services and positively impact population health and well-being.

RW: What are some of the common challenges APHSA members are facing in purchasing and implementing IT services to support their integration objectives?

TWE: Many state and local agencies are bogged down by outmoded, legacy IT systems, and the budget pressure that they face is daunting. There are so many competing priorities – state and local governments are in a tough position when it comes to allocating funds, and are constantly looking for efficiencies in both process and costs.

RW: Could you share some insight on some of the work APHSA is undertaking to support your member efforts in this area?

TWE: Our collaborative center, the National Collaborative for Integration of Health and Human Services, in concert with our members and private industry partners has produced a number of toolkits and guidances to help our members with their integration initiatives. Most recently, it published a Guide to Data Management, Privacy & Confidentiality, and Predictive Analytics which lays out the building blocks of a data sharing strategy. The National Collaborative is at the forefront of H/HS systems integration, and our members and partners have done an incredible job at highlighting successful integration efforts and helping states and localities implement innovative technologies.

Join Tracey on: Thursday, April 5 • 10:45am – 11:45am Track 3: PLENARY – Designing for Impact in Integrated Service Delivery 2018 Healthcare IT Connect Summit



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Deb Grier, VP Enterprise Product Management, HMS sat down with Healthcare IT Connect’s Rob Waters to discuss innovations in Third Party Liability (TPL) solutions and how the evolution towards real-time eligibility determination is enabling states to move towards ‘cost avoidance’ based strategies and away from ‘pay and chase’.

Rob Waters: Third Party Liability represents one of the largest cost-savings opportunities for states to control costs and manage budgets, what should states be thinking about when they are examining the opportunity to evolve TPL to ‘Cost Avoidance’ and away from ‘Pay & Chase’?

DG: Emphasizing robust cost avoidance strategies will deliver improved financial results for states.  Back end recovery efforts are impeded as insurers impose more network and prior authorization requirements, which can be successfully managed on the front end. States need to be ready to adopt these strategies and embed them in their eligibility, financial, and claims management processes. Additionally, states must educate their partners and stakeholders on how these changes will affect them, and why they are important.  HMS can offer support to states in developing financial models that will demonstrate the value of cost avoidance and support funding requests and approaches.

While implementing front end cost avoidance strategies is essential, post-payment processes will still be necessary. Medicaid members’ circumstances change often; and the data discontinuities that occur between reporting changes, eligibility decisions, and claims submission can result in  primary payment by Medicaid when another party may be liable.

Additionally, federal guidelines still require states to pay up front for certain services and recover on the back end; and states are at varying readiness levels to adopt specific cost-avoidance strategies. For all these reasons, when looking to bolster cost savings opportunities, we recommend that states consider all transactional points along the healthcare continuum, from enrollment to post claims submission, that will be best served by the insertion of third party insurance identification and verification before a claim is paid by Medicaid. 

RW: What are some of the innovations in TPL that are enabling states to move to ‘real time’ coordination of benefits as part for the eligibility determination process?

A Medicaid member’s access to third party insurance is dynamic, which creates the need to inject TPL faster, more frequently and at more instances than have been historically considered.  While capturing a continually updated TPL status for all Medicaid members remains vital, HMS is focusing on innovations that bring forth TPL at the point of enrollment, point of prior authorization reviews and point of provider service and billing.  TPL data, while available at those junctures today, is often accessed manually.   HMS’s Enhanced Cost Avoidance suite of services removes the labor-intensive – and oftentimes overlooked – burden of this activity to support effective operations and ensure cost savings are maximized.

RW: How do these innovations align with the modular modernization of MMIS?

DG: HMS designed the technology platform that powers our enhanced cost avoidance suite of services with a decoupled strategy at its core. Our components are modular and flexible, providing services through well-defined API’s. This structure fosters reuse across multiple states and the opportunity for states to mix and match elements of our solution with their existing or planned systems. The platform aligns today with the MITA Modularity standard, with components that are built following a MicroServices approach that can be rolled-up to provide functionality for one or more business processes as defined in MITA business process model. In addition, the platform makes use of a business rules engine, thereby externalizing business rules from programming logic.

RW: What are the procurement options and funding mechanisms available for states to modernize their TPL systems (technology, services, re-use)?

DG:As the MMIS transforms to the Medicaid Enterprise System (MES), Medicaid agencies are faced with a decision on how to treat their TPL functions. With this shift in focus to system modularity, preserving cost containment functions is critical. A complete TPL solution is made up of a combination of data driven deliverables (such as cost avoidance and recoveries) and process driven services (such as subrogation recovery, premium assistance programs, and post payment recovery).  When preparing TPL procurements we recommend the following considerations:

• Understand your state’s TPL needs

• Consider your staffing constraints

• Ensure TPL staff have input on procurements

• Avoid forcing artificial partnerships

• Maintain continuity of recoveries and focus on the best results for all stakeholders

Our recommendation is to position TPL as a standalone procurement, either as its own module or as a service driven procurement, while creating greater interoperability with the core MES through the use of technology that facilitates information and data sharing. Regardless of the approach taken to procure and position TPL, our technology and services have been developed to integrate and exchange data seamlessly with other functions and modules.

Join Deb Grier on: Thursday, April 5 • 4:00pm – 5:00pm Track 4: Evolving Third Party Liability (TPL) towards ‘Cost Avoidance’ and beyond ‘Pay & Chase’, exploring state modernization and procurement models . | . 2018 Healthcare IT Connect Summit

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Eugene Sayan sat down with HITC’s Rob Waters to look towards the next phase of healthcare reform and to discuss some of the organizational and IT strategies states may want to consider to meet with the demands of a more modular and integrated H&HS ecosystem.

Rob Waters: Can you give a more in-depth description on the services you provide to payers and governments and how you differentiate yourself. How does Softheon deliver value to solve their challenges?

ES: Softheon provides an array of Medicaid reform technologies for both Medicaid Managed Care Organizations (MCO) and governments, including premium billing, eligibility verification, WRAP program management, delinquency & reconciliation, financial management, and data analytics. One of Softheon’s most valuable services is our agility. We differentiate ourselves from our competition by the fact that we have been able to adapt and thrive in a very unstable market. We are the industry pioneers working with early innovative states and plans. Some of our state partners include Indiana Healthy Insurance Plan (HIP 2.0), Arkansas Private Option (PO), New Hampshire Premium Assistance Program (PAP), New York Basic Plan (BP), and Kentucky Health.

RW: As states look towards the next phase of Medicaid transformation and marketplace reforms, potentially with more autonomy as to how they serve Medicaid populations. What do you see as the main opportunity for states to implement more ‘citizen focused’ services?

ES:  With the approval of Section 1115 Demonstration Waivers, states are getting more creative in serving their Medicaid populations. We’re seeing work requirements already approved in Kentucky and Indiana, and pending in AZ, UT, KS, AR, MS, WI, NH, and ME. Using 1115 Waivers along with 1332 ACA waivers has also come up in a few states recently, when making changes that impact both commercial and Medicaid lines of business.

In Idaho, there is an ongoing conversation about people that make too much to be on Medicaid but don’t hit the federal poverty level threshold to get tax credits. After proposing stopgap measures for years, this year they are trying to tie Medicaid and commercial changes together. This could impact more than 20,000 Idahoans, providing Medicaid eligibility through establishing a small eligibility group via the 1115 waiver.

Politics aside, the purpose of these waiver requests is for citizens to share a personal responsibility when using Medicaid funds, reducing waste while adding accountability for these people to proactively receive care.

Medicaid programs across the country are observing very interesting numbers: South Carolina recently saw a 29 percent drop in opioid prescriptions. According to the Lewin Report released last March, the majority (>50 percent) of HIP 2.0 Plus members could ‘always’ or ‘usually’ get routine appointments, get their prescriptions filled, and felt that the premiums were justified and were willing to pay a small monthly premium of $5 or more.

Reducing waste and increasing care are always the main opportunities with reforms, and the idea is to have ‘skin in the game’ so that the Medicaid population gets preventative care which leads to healthier population which leads to fewer claims, and so on.

RW: With a burgeoning ecosystem of ‘modular’ products and services now available for state Medicaid modernization, how does this align with Softheon’s approach and how you engage with your state customers?

ES:  Softheon’s cloud-based platform is comprised of modular components, architected to support modular implementations and mitigate the risk and uncertainty associated with ‘rip and replace’ challenges. This helps to set us apart, as other vendors attempt to extract code and bring new problems to otherwise functioning technologies. Health plans, MCOs, and states can avoid these risky extractions and the burdensome re-deployments. We offer these solutions as part of the Softheon Medicaid Administrative Cloud (MAC), which provides end-to-end functionality.

Since each state has its own unique approach to Medicaid, it can often be difficult assessing each individual need through our own gap analysis. Once we contact the state’s representatives, we show our main value proposition: MAC. With MAC, we reduce the need for IT infrastructure, dedicated personnel, and costly maintenance fees. Our value proposition is clear; the Cloud is the cheaper, faster, more secure option.

RW: The shift towards ‘modularity’ and away from ‘rip and replace’ has also put a lens on the re-use and integration of legacy IT investments. What advise do you have states when considering their data integration strategy?

ES:  I don’t necessarily think that ‘modularity’ and ‘rip and replace’ are antithetical to each other. We have seen many times, both in ACA and Medicaid, that carriers are willing to abandon their legacy IT strategies- provided the solutions are more affordable and easier to use. There are not many systems that can cover all the needs of a state or MCO. You have some systems that only cover billing under 1115 waivers, or some that only do eligibility verification. That is where the issues arise; these systems don’t or can’t communicate with each other or are inefficient. You would also need costly upgrades or licensing fees.

Of the 33 states that have expanded Medicaid, the amount of money that can be saved by having an integrated data strategy is immense. We already have seven states that have expanded programs using 1115 Waivers, and more are pending. The need for communication between states, providers, and members is paramount.

My advice to states that are considering data integration strategies are to look for a platform that can accommodate all of your needs: connect to the core system and speak the same language; have one modular platform that can do billing, enrollment, eligibility, analytics, and more; mitigate the risk and complexity away from built-in infrastructure to a cloud service; and finally, look for a service that is regularly upgraded and updated at no cost to you.

RW: How do you envisage these trends impacting future state procurements and the evolution of state IT workforces?

ES: Future state requirements will be a platform that is lean, secure, fast, stable, and modular. States will seek out systems like Softheon’s MAC to fulfill these requirements. We’ll see the move soon from Medicaid Management Information Systems (MMIS) throughout state and federal programs to more modular platforms. We need to get these disparate governmental systems to talk to one another; carriers, MCOs, providers, and members should have a platform that is easy and light that can securely communicate vital EHR and EMR to one another. We’re already seeing the move for Medicaid onto Amazon Web Services cloud to run analytics on 74 million lives. Wyoming has been using Google Apps for Government, NEOGOV for human resources, and other cloud-based platforms.

Medical loss ratios (claims paid out as a percentage of premiums) has improved, averaging 81% through the third quarter. This shows that markets have begun to stabilize, and health plans are returning to profitability.

I believe that the workforce population will remain the same, if not grow, but the specializations will change. The cloud is the natural progression of technology; there is less cost overall with faster implementation, and it can be accessed via secure website portal login. You will see less people being tasked with maintaining servers and infrastructure, thus freeing up personnel and capital to better manage their members.

This paradigm shift will enable states to focus more on quality of care and increase the ability to fight fraud, waste, and abuse. The cost savings will lead to lower premiums for the member population and greater overall satisfaction.

Join Eugene Sayan on: Thursday, April 5 • 2:45pm – 3:45pm Track 5: State Innovation Design and Implementation: Addressing ACA Marketplace Sustainability, Reform, and Positioning . | 2018 State Healthcare IT Connect Summit


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Contributed by Matthew Moreau 
Matthew Moreau is the VP Solution Strategy, Government Healthcare Solutions, Conduent

As technology has advanced, Medicaid platforms have become increasingly complex. To help States successfully and efficiently modernize their platforms, CMS has guided them to break their procurements into smaller pieces so multiple vendors can work on facets of the project in which they have the most expertise.

As a result, system integrators are tasked with working in conjunction with each modularity vendor, connecting disparate technology and ultimately keeping the project on track.

My colleagues and I recently had the opportunity to discuss the role system integrators play in supporting platform modernization projects during a standing-room only roundtable session at the 2017 State Healthcare IT Connect Summit. Three themes rose to the top of our conversation:

1. Change management.
All parties are still adjusting to multiple vendors being involved in a Medicaid modernization project. The system integrator often enters an agreement while there is still much uncertainty with active procurements for the platform modules. For instance, the system integrator may not be aware of what the specific technology solutions module vendors will use, or even the vendors that will be involved in the project.

2. Accountability vs. authority.
The overall goal for the system integrator is to create an environment in which different vendors can work collaboratively, and ultimately ensure a project is completed on time. But at the same time, the system integrator might not always have the authority to take action when needed to meet those goals. An important question for State Medicaid programs to consider and system integrators to understand is, “when there’s a bump in the road and something goes sideways – what authority does the system integrator have to make or impact change?”

3. Contracting terms.
Contracts need to align with accountability and authority, and need to be as clear as possible in the role of the system integrator. It’s important for States to make their contracts appealing for bidders while still protecting themselves and ensuring a cost-effective implementation. Vague contract terms create risks for both parties (State and vendor) and often forces vendors to add assumptions and contingencies to their bid during the procurement process.

Conduent has extensive experience in Medicaid management, providing administrative and care management solutions to Medicaid programs and federally funded U.S. government healthcare programs in 26 states, Puerto Rico and the District of Columbia. Conduent has also received CMS certification for its Pharmacy Benefit Management module, the Conduent Flexible Rx System. We expect the role of the system integrator to become more standardized as more States begin their modernization projects. We look forward to observing how the system integrator role continues to evolve and continuing this conversation at next year’s State Healthcare IT Connect Summit!

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Everyone is talking about it. Customer Experience.
Tish Falco, contributor.  
Tish Falco is a Senior Director, Customer Experience, at General Dynamics Health Solutions.

It’s the latest buzzword that companies and organizations are chasing – but, truthfully, it is so much more. What does Customer Experience (CX) really mean? In its most simple form, CX is how a customer perceives their interactions with an organization. Beyond customer service and customer satisfaction, CX is how a customer views all interactions across all channels over time – not just during a single engagement with one person or channel (i.e. talking to a customer service agent to understand a recent bank transaction). CX looks at the entire customer journey to identify how interactions are related and where there are dependencies –considering the collective, various interactions across the customer’s relationship with the organization to truly understand the customer’s needs, wants and expectations. Below are five key steps for implementing a successful CX program.  

1. Develop a Clear Strategy and Vision
Based on citizen guidance, determine what future experience you want to deliver and ensure it is in-line with what customers want and employees can deliver.

2. Embrace Customer Insights
Through various forms of data, understand your customers’ needs, wants and expectations.
Leveraging tools like surveys, focus groups, voice and text analytics, and social sentiment can define the voice of your customer, driving strong CX improvements.
It’s not enough to collect this information, you also need to gauge how well you’re doing – CX plans should be actionable and measurable to allow for adjustments based on how well an agency is doing.

3. Align Technology and Processes
To avoid disjointed CX, use insights to make agile changes to both technology and processes for continuous improvement. As both are intertwined, it’s important to understand the dependencies and shape changes when making CX improvements.

4. Operationalize CX at the Right Level

  • To truly be successful, CX must be a strategic initiative, not a flavor of the month directive.
  • Create an organizational structure that is empowered and has sufficient, dedicated resources to help shepherd CX throughout the agency.

5. Transform Culture for Organizational Change

  • One of the most important ingredients in making CX sustainable for the long haul is focusing the same energy on employees as the customer.
  • Make CX part of your DNA by looking at how you engage your employees in their efforts to embrace CX – hire for and develop skills as well as provide rewards, training and the necessary tools for your people to be successful.

With the balance of power shifting from organizations to customers – due to citizens becoming more demanding, having better access to information and the ability to spread perceptions via social media – agencies must continue making strides to embrace CX and close the divide. Citizens come to expect fast and easy service using multiple devices with access anywhere, anytime. Based on private sector experiences, there is a need for agencies to start bringing the citizen’s voice to the decision-making table. The consequences, in addition to customers finding workarounds, is the potential for unwanted media attention and scrutiny that will negatively influence budgets, and ultimately, agency missions.

Contact General Dynamics Health Solutions at to learn how we can help develop a cloud solution that meets your technical requirements, business functionality and budget. To learn more about our cloud solutions, visit   

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Joseph Fiorentino, Managing Director H&HS, Accenture
sat down with HITC’s Rob Waters to understand more about the challenges states are facing in realizing the potential of their data analytics programs and to discuss the creative approaches being employed by states to engage with the vendor community to support actionable and timely insights to better serve their service re-design efforts.

Rob Waters: H&HS agencies hold huge potential in terms of the varied data stores they manage to measure performance and improve outcomes – what are some of the challenges states are facing in realizing this potential?

Joseph Fiorentino: Agencies are trying to move beyond compliance and operational approaches to creatively use data to reinvent service delivery and build a stronger network of care, however, many are struggling to glean value from data. A few factors are holding back progress. These include:

• Data privacy and security issues – This is the biggest barrier. Sharing data across an ecosystem is not without challenges for most agencies. Even those with good intentions often face legislative, process, cultural and confidentiality obstacles. Adaptive leadership approaches and creative strategies will help agencies to overcome this barrier.
• Demand for new skills – Analytics professionals today need new and more complete skillsets—a combination of business, data science, visual aptitude and technology, among other skills. These skills are in tremendous demand in the marketplace, and agencies must retain this type of talent to maximize their data.
• Architectures – Big data architecture must work hand-in-hand with traditional architecture to satisfy more complex analytics needs. Hybrid is the new reality to increase value.

RW: In a world of finite resources and often burdensome data-usage regulations, how are states evolving their approach to analytics to yield actionable insights in a timely manner?

JF: Agencies need a new data mindset if they are going to use data to improve decision-making, align finite resources, measure performance and improve outcomes.

Agencies that want to develop their own targeted analytics programs and get results quickly need different tools than most might expect. Many decision makers think that they must start with infrastructure. They assume the first step is to invest in data warehouses, data stores and the hardware and software necessary to support them. This is an expensive, unnecessary heavy lift—a three- to five-year project that often times does not yield desired results for data analytics.
Agencies have exciting opportunities to get straight to using data insights to benefit citizens. Rather than focus on infrastructure, agencies should focus on extracting value from the data they have, using fast, innovative methods. The key is to identify a specific problem or question to address and “work backward” to determine the data insight needed to solve it.

With this narrow focus, agencies can apply methods, such as rapid prototyping or rapid cycle evaluation, to reduce delivery time and improve services faster. These methods take weeks, not years, speeding insight to action. They are also highly adaptive, giving agencies newfound freedom to take risks and experiment with analytics. Agencies finally have room to “fail fast and fail small,” making near real-time course corrections to program approaches to manage risk while supporting a continuous focus on outcomes.

RW: Increasingly states are referencing the role of ‘partnership in analytics’, how have you seen the relationship between vendor, agency staff and policy makers evolve over time?

JF: To a certain extent, reform programs are driving progress as agencies are looking for creative strategies to share data and adopt analytics. Agencies recognize that traditional procurement processes and difficulty sharing data across an ecosystem are a challenge. Legislative, process, cultural and confidentiality barriers hinder even the best intentions.

Rather than struggling through a typically lengthy RFP process, agencies are having firms prequalify by participating in a “bake off” of their solution. This approach has benefits because it drives an infusion of innovation as firms big and small respond to projects. However, there will need to be a great deal of coordination and governance as agencies try to manage multiple vendors working off the same data using different techniques and technologies.

RW: For states who are currently re-assessing their H&HS analytics strategies, what advice do you have in terms of engaging the vendor marketplace and structuring procurements for optimal outcomes?

JF: An analytics RFP should encourage creativity and innovation. Engage with the marketplace prior to the RFP by fostering conversations and work sessions between the agency and the vendor.

Agencies should be transparent, if they have a strategy in mind, share it, and have the vendor community comment on it. Try to avoid product specifics, where possible, to keep the door open to new ideas and new approaches when communicating with the vendor community. One approach that is gaining traction is to prequalify vendors rather than go through a lengthy RFP process and select one vendor. After prequalifying vendors, work collaboratively with those vendors and have them compete on smaller projects. This gives agencies newfound freedom to take risks and experiment with analytics. In this model, agencies have room to quickly make course corrections on the relationship with the vendor.

Accenture is the Track 2 Sponsor: State Innovation, Data Analytics and Population Health Management *Accenture’s Joseph Fiorentino will also be co-presenting the track session as detailed below on Day 2 of the conference.
March 29th, 11.30 a.m.12.30 p.m EDT
Track 2
Analytics Make My Head Hurt! A Prescription for Actionable Insights

Joseph Fiorentino, Managing Director, Health and Human Services, Accenture
Martin Baker, MSc, Senior Director, Strategic Growth and Business Development, UMass Medical School

Register to Attend the 2017 State Healthcare IT Connect Summit | March 28th – 29th | Hilton Baltimore, Baltimore MD.

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Rob Waters, VP and Program Director with Healthcare IT Connect sat down with Mark Settle, Okta, CIO to learn more about Okta’s recent selection by CMS to support it’s identity architecture and to discuss the broader implications of cloud based ID management solutions for H&HS transformation!

Rob Waters: I’d like to initially congratulate Okta on your selection by CMS to help streamline and modernize it’s identity architecture, could you elaborate on the work Okta will be undertaking there?

Mark Settle: Thank you! CMS selected Okta to provide the Okta Identity Cloud as a key enabling technology for CMS’ Quality Payment Program (QPP). Over one million health care providers across the U.S. seek CMS reimbursement for their services via QPP. Okta provides cloud-based solutions for identity and access management. We were specifically selected for our agility (ability to scale rapidly and provide coverage for all CMS caregivers), user experience (simplifying the use of multiple user names and passwords) and security (end-to-end encryption and early detection of anomalous login behaviors). The Okta Identity Cloud is also extendable to other applications and services CMS may want to pursue in the future.

RW: Where does this fit into CMS’ overall modernization efforts and how will the solution ultimately impact CMS’ ability to better serve its’ constituents?

MS: Agility, user experience and security are foundational elements of the overall digital transformation that is occurring at CMS. Balancing ease of use with security is a tough task for any enterprise, but doubly so for a federal agency handling reimbursement for medical services provided to individual citizens. The Okta Identity Cloud provides single sign-on, directory management, user provisioning and multi-factor authentication, which can be deployed and adapted to achieve the appropriate balance for CMS’ mission, not only in the context of the QPP program but for other programs as well. Okta’s comprehensive solutions for identity and access management allow CMS to focus on what its stakeholders really want, namely a secure and seamless experience.

RW: Many states are beginning to take a ‘Cloud First’ approach to their application procurements, what advice do you have for states who are considering cloud services for their H&HS transformation efforts?

MS: All enterprises that embark on a cloud-first journey have to overcome deeply engrained phobias about the reliability and security of cloud-based services. They typically challenge the cloud vendors to prove that they are perfectly reliable and secure. That’s really the wrong question to ask. The enterprises should be asking themselves if they can deliver comparable services more reliably and more securely than the cloud vendors! The answer, almost invariably, will be “no” because cloud services are required to meet certain security standards. My second piece of advice is to achieve a critical mass of cloud-based services as quickly as possible. True business agility is realized when a combination of cloud-based services is used to deliver all or most of some type of business process. Adding only one or two cloud capabilities to an existing application architecture will not produce the transformational results that most enterprises are seeking. At the same time, these new cloud-based solutions can be accessed on demand, from anywhere in the world, as long as the person is an authorized user.

RW: From a maintenance and management perspective what advantages does this approach bring to an IT organization in the long term?

MS: Bringing on cloud applications and services will take an organization out of the business of buying hardware and operating data centers, and allows them to focus on delivering new and better services through an interface that is more intuitive, personalized and secure than anything they’ve offered in the past. Reliable infrastructure operations are presumptive table stakes to any customer or end user. The name of the game going forward is customer experience. Infrastructure maintenance responsibilities are, in effect, a distraction from delivering the business functionality and ease of use that end users are really seeking. Okta, and other cloud-based service providers, can relieve IT organizations of this distraction.

RW: Okta’s principal offering is branded as the ‘Okta Identity Cloud’, can this solution be integrated into any application environment?

MS: Absolutely. We think of the Okta Identity Cloud as the foundation for secure connections between people and technology. Okta is actually embedded in a variety of commercial services such as Adobe’s Creative Cloud and Ring Central’s unified communication products. Access to Adobe and Ring Central’s services is authenticated via Okta — without any interruptions to the user experience. Okta has a 100% API driven architecture which enables its integration into virtually any application environment. Additionally, Okta offers deep integrations to over 5,000 cloud and web-based commercial services via the Okta Application Network (OAN), making Okta the “easy button” for IT shops seeking to expand the use of cloud-based applications in the future.

Join Okta on:

“Centers for Medicare and Medicaid Services: Identity is key for a Secure, User-friendly Experience” on Tuesday, March 28, 3:45 p.m.
Register to Attend the 2017 State Healthcare IT Connect Summit | March 28th – 29th | Hilton Baltimore, Baltimore MD.


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Eugene Sayan, Softheon’s Chairman, CEO & Founder sat down with Healthcare IT Connect’s Rob Waters to discuss the expanding role of integration and analytics in a cloud and services based world and how Softheon feels it is uniquely positioned to thrive in this future landscape.

Rob Waters: Can you tell us about your company, Softheon, its corporate culture, and how that culture extends to the quality relationships you establish with clients?

Eugene Sayan: At Softheon we strive to create simple solutions to complex problems. We are headquartered in Stony Brook, NY and the majority of our workforce has graduated college within the last five years. What we lack in experience, we make up for in determination and focus. Our culture then isn’t just about working hard, but at its core it comes down to the relationships we build with each of our clients. We have been able to build these lasting relationships through open communication channels, collaboration, and an overall willingness to handle anything that comes our way. This is the reason we use the term ‘partner’ rather than ‘client’: our relationships are paramount, and all other activities are an extension of this fact.

RW: Can you give a more in-depth description on the services you provide to payers and governments and how you differentiate yourself. How does Softheon deliver value to solve their challenges?

ES: Softheon provides a variety of services to both payers and governments, including automated premium billing, payment gateway, HIPAA EDI validations, and advanced data analytics. Our platform is able to take data from a variety of disparate sources and converge into a meaningful repository, which can in turn streamline a number of ancillary processes. One of Softheon’s most valuable services (outside of the Software itself), that we provide to both payers and government agencies, has to be our agility. We differentiate ourselves from our competition by the fact that we have been able to adapt and thrive in a very unstable market.

RW: You previously forecasted that a supply chain transformation where healthcare payers would govern, rather than own, their data assets. Has this vision come to fruition?

ES: With regards to payers governing, rather than owning their data assets, we can already see this shift occurring by the fact that a number of payers are adopting cloud-based, value-added solutions. Payers now have less of a need for expensive hardware infrastructure, and can employ a leaner technical team.

At the same time, these new cloud-based solutions can be accessed on demand, from anywhere in the world, as long as the person is an authorized user.

RW: Where do see advanced analytics and integration going?

ES: We see advanced data analytics and integration becoming more and more prominent in the healthcare space, both for payers and government agencies. These analytics are already being used today for tasks such as plan design and target market outreach. The demand for real-time integrations is also becoming a more popular topic, as customers want their metrics as soon as they are available, and want their partners to be on the same page. We see this as building the healthcare ecosystem, which can then in-turn create a better system for all stakeholders.

Join Softheon on:

“HIX 2.0: Considering an Exchange Operator” on Tuesday, March 28, 3:45 p.m.

Register to Attend the 2017 State Healthcare IT Connect Summit | March 28th – 29th | Hilton Baltimore, Baltimore MD.

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