MESC 2025 Tracks and Themes

Track 1: Modernizing the Medicaid Enterprise:

This track focuses on navigating the future of Medicaid through  advancing interoperability and data exchange, optimizing procurement and implementation, streamlining modular certification, and building resilient and adaptable systems. For example:

• Advancing Interoperability and Data Exchange: Addressing challenges and opportunities in implementing CMS Interoperability Rules.
• Optimizing Procurement and Implementation Strategies: Best practices for RFP development, proposal review, vendor selection, and project management.
• Streamlining Modular Certification (SMC): Lessons learned and future directions for ensuring successful systems certifications.
• Building a Resilient and Adaptable Medicaid Enterprise: Strategies for risk mitigation, disaster recovery, and business continuity including the use of cloud computing.

Track 2: Operational Excellence and Compliance:

This track emphasizes enhancing operational efficiency, addressing health-related social needs, meeting evolving regulatory requirements, and improving the member experience. For example:

• Enhancing Operational Efficiency: Optimizing workflows, automating processes, and improving user experience.
• Meeting Regulatory Requirements: Staying compliant with evolving federal and state regulations.
• Improving Member Experience: Enhancing access to care, simplifying enrollment processes, and providing personalized services.

Track 3: Data-Driven Decision Making and Analytics:

This track explores utilizing data analytics for better outcomes by applying advanced analytics and predictive modeling, leveraging real-time data and insights, ensuring proper data governance, privacy and security, and facilitating data sharing and interoperability. For example:

• Data Analytics for Better Outcomes: Utilizing data to identify trends, predict risks, and improve program performance and outcomes.
• Advanced Analytics and Predictive Modeling: Applying advanced analytics techniques to inform strategic decision-making.
• Real-Time Data and Insights: Leveraging real-time data to enable timely interventions and improve operational efficiency.
• Data Governance and Security: Ensuring data quality, privacy, and security.
• Data Sharing and Interoperability: Facilitating seamless data exchange with other health and social service agencies

Track 4: Integrated Eligibility and Enrollment (IE&E):

This track centers on streamlining IE&E processes, enhancing the member experience, leveraging data analytics for IE&E, addressing complex eligibility issues, and integrating IE&E with other Medicaid systems. For example:

• Streamlining IE&E Processes: Automating workflows, reducing processing time, and improving accuracy.
• Enhancing Member Experience: Providing user-friendly self-service portals and simplifying enrollment processes.
• Leveraging Data Analytics for IE&E: Using data to identify eligibility trends, target outreach efforts, and prevent eligibility gaps.
• Addressing Complex Eligibility Issues: Developing strategies to handle complex cases and ensure accurate eligibility determinations.
• Integrating IE&E with Other Medicaid Systems: Ensuring seamless data exchange and coordination between systems.

Track 5: Program Integrity, Fraud, Waste, and Abuse:

This track delves into advanced fraud detection and prevention, enhancing data analytics for program integrity, strengthening provider enrollment and monitoring, improving coordination of benefits and third-party liability processes, and enhancing overpayment recovery. For example:

• Enhancing Data Analytics for Program Integrity: Utilizing data to identify patterns of fraud, waste, and abuse.
• Strengthening Provider Enrollment and Monitoring: Implementing robust provider enrollment and monitoring processes.
• Improving Coordination of Benefits (COB) and Third-Party Liability (TPL): Optimizing COB and TPL processes to reduce improper payments.
• Enhancing Overpayment Recovery: Implementing effective strategies to recover overpayments.

Track 6: Artificial Intelligence (AI) and the Future of Medicaid: A Vision for 2030 and Beyond:

This track examines future trends and challenges in Medicaid, explores AI governance structures, discusses current and future uses of AI in managing Medicaid programs, and analyzes how AI will transform data analytics, claims processing, eligibility determinations, document verification, and program integrity/cost avoidance. For example:

• Anticipating future trends and challenges in the Medicaid landscape
• How will SMAs structure AI governance?
• Uses, current and future, of AI in managing Medicaid programs
• How will AI change:
• Data analytics
• Claims processing
• Eligibility determinations
• Document verification
• Program integrity and cost avoidance
• Provider and Client Services (e.g., Call Centers)