The Medicaid Enterprise Systems Community is pleased to host a three-part webinar series as follow-up from the annual Medicaid Enterprise Systems Conference 2021. These sessions encountered technical difficulties which prevented virtual attendees from fully participating in the sessions. The schedule of sessions includes the following:
October 12, 2021 – Putting Social Determinants of Health Data to Work
Empirical evidence shows the relationship between social determinants of health and health outcomes. Vulnerable residents across the U.S. served by Medicaid and safety net systems are particularly susceptible to the impact of lack of whole person care. They cycle through the emergency room for medical care, homeless shelter for housing, and the food bank for groceries. Incarceration and use of emergency services are strong indicators of unmanaged chronic disease. These overlapping and symbiotic needs require an integrated and coordinated delivery system to influence positive health outcomes and ensure efficient use of funding. In addition to being costly, these interactions with public and private systems overlook key needs and often fail to provide long-term, sustainable, and positive outcomes. To realize an individual’s full potential, the individual deserves a coordinated system of care that recognizes her/his holistic needs. At this session you will learn how Riverside County is using data and advanced analytics to provide a more complete, accurate picture of community need as well as evaluate the impact of services. Participants will learn about data architectural concepts better suited for the ever growing need to use disparate data to track outcomes.
- Dr. Judi Nightingale, Director of Population Health for Riverside County
- Josh Morgan, National Director of Behavioral Health and Whole Person Care, SAS
- Daria Rostovtseva, Data Scientist, SAS
October 26, 2021 – How Open APIs Promote Interoperability and Value in Medicaid
The CMS Patient Access and Interoperability Final Rule (Final Rule), published on March 9, 2020 requires that, beginning January 1, 2021 state Medicaid Agencies and Medicaid Managed Care organizations make available Patient Access Application Programming Interfaces (APIs) to provide patients with information relevant to their care. Specifically, the Final Rule will require that Patient Access APIs be based on the Fast Healthcare Interoperability Resource (FHIR) version 4.0.1 and be standards-based. On July 30, 2019 the private sector released the CARIN Blue Button® data model and draft implementation guide as part of the White House Blue Button® Developers Conference. The data elements in the implementation guide are included in the common pay consumer data set and have been mapped to HL7 FHIR resources to assist with compliance with federal regulatory obligations as described in the Final Rule. However, the utility of APIs extends beyond regulatory compliance, and several states and developers have used the Carin Blue Button framework to develop an implementation guide for Medicaid that will help state Medicaid vendors, payers, and providers to pursue value in Medicaid through an interoperable ecosystem enabled by APIs.
- Ryan Howells, Leavitt Partners
- Sashi Ravipati – SVP, Products, CNSI
- Jeff Strand – Business Architect, Gainwell Technologies
- Hermanth Veradhan, Director of IT, Conduent
- Jake Dawley, State of Nevada
November 2, 2021 – Next Generation TPL: Changing the Game for State Medicaid Agencies
Third Party Liability strategies remain a key oversight component for state Medicaid programs. After decades of stagnant approaches, we know that process improvements and advances in technology can drive greater results. But to exponentially advance both cost avoidance and recovery opportunities, it is critical for state Medicaid agencies to achieve greater simplification and to address long-standing conflicting incentives for state Medicaid agencies and managed care organizations. Next Generation TPL models are harnessing the power of artificial intelligence, cloud capabilities, and advanced training methodologies to uncover hidden value and realign operating models for even greater process and workforce optimization.
- Denise Poley, National TPL Offering Lead, Accenture
- Christine Hansen, National TPL Delivery Lead, Accenture
- Shawn Hatton, East Regional TPL Lead, Accenture
- Paula Mendoza, TPL Delivery Manager, Accenture
All sessions are scheduled for 2:00-3:00 PM ET.
There are no registration fees for these virtual events.