Public Payers News

CMS Seeks Input to Implement Modular Medicaid IT Solutions

The federal agency is looking for more input regarding pre-certification of modules and Medicaid IT solutions in order to streamline their creation and implementation.

By Vera Gruessner

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a request for information called Modular Solutions for Medicaid IT Enterprise and Pre-certification of Solutions. Essentially, CMS is seeking more information regarding Medicaid IT solutions and management of clinical and administrative data.

Health Information Technology

The federal agency gives $5 billion annually for states to create and manage Medicaid Management Information Systems. These Medicaid IT solutions are used for claims processing, enrolling providers in the network, reimbursing claims, and managing beneficiary enrollment and benefits.

CMS is currently promoting modular platforms for state Medicaid IT solutions and enterprise systems in order to increase competition in the marketplace as well as reduce the need to customize and configure data storage tools. Most importantly, CMS is looking for modules that would improve care management and health information exchange between state Medicaid agencies as well as other public agencies that provide health coverage benefits.

“Among other things, CMS is interested in promoting the development of modularity, considered here as both business modules and shared services, aimed at improving care management and health information exchange for state Medicaid agencies and other agencies providing person-centered services and benefits,” the request for information stated.

“CMS is developing a process for vendors to voluntarily obtain pre-certification for their MMIS [Medicaid Management Information Systems] modules as a means of streamlining the path to MMIS certification. To this end, CMS invites public comment regarding voluntary module pre-certification process and its potential benefits, drawbacks, and challenges.”

Through the request for information, CMS is seeking public comments regarding the implementation of modular solutions for Medicaid enterprise systems especially when it comes to clinical data storage. Additionally, the federal agency is looking for more input regarding pre-certification of modules and Medicaid IT solutions in order to streamline their creation and implementation.

This request for information could further help develop policies and decisions regarding the direction Medicaid IT solutions will move in the coming years. According to Medicaid.gov, CMS is beginning a program that allows vendors and companies to submit module Medicaid IT solutions for pre-certification.

This will allow for a more streamlined and cost-effective approach to adopting new technologies among state Medicaid programs. Once these modular tools are added to the precertification list, Medicaid programs will be encouraged to adopt the health IT solutions when it’s time to consider purchasing decisions.

State Medicaid programs and public payers are not the only ones who need superior health IT tools. Private, commercial insurers benefit significantly from adopting innovative health IT systems especially since there is more focus on data analytics and a complete switch taking place from the traditional fee-for-service payment system to value-based care.

Earlier this year, a few payers had experienced certain missteps with regard to technological issues. For instance, the health payer Centene had lost six hard drives that held data of 950,000 policyholders. The insurer lost information regarding social security numbers, names, member ID numbers, and addresses.

The privacy and security of health IT systems is a major necessity for the health insurance industry and health payers will need to bring strict adherence to the HIPAA law when managing enrollment data and claims. In North Carolina, their local Blue Cross and Blue Shield also faced a large number of enrollment issues at the beginning of 2016.

From incorrect billing information to enrolling people in plans they did not choose, the health IT systems of Blue Cross and Blue Shield faced some serious problems. Private health payers will need to invest time and resources in preventing such issues from occurring in the future.

“Information technology is an imperative for payers,” Kimberly Branson, the ‎Vice President of Business Architecture & Strategy at health insurance company Medica, told HealthPayerIntelligence.com. “From a core administration perspective, the core responsibility of a health plan or a payer is to finance healthcare.”

“The way that it’s done is pretty complex between the payer and the provider. Having information technology that helps to automate workflow and automate the transfer of information within and in-and-out of a health plan is critically important,” she continued. “In an age where the industry is becoming even more and more focused on government oversight and compliance, improving automation improves quality, which improves your plan’s capability on ensuring compliance as well.”

“Technology, from my perspective, is as important as the people and is as important as the process.”

It is also important to note that CMS has began moving away from meaningful use requirements when issuing rulings regarding the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). The federal agency will be bringing more policies aimed at improving coordination and interoperability between health IT systems.

Both public and private health payers will need to continue evolving their technologies in alignment with the changing healthcare landscape. This involves adopting more data analytics software to manage population health management and adhere to value-based care reimbursement processes. As CMS continues to seek further input, health payers and vendors can work together to present more effective modular health IT solutions.

 

Dig Deeper:

Coordination, Interoperability Key for MACRA Requirements

Merit-Based Incentive Payment System Transforms Meaningful Use