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Bridging the gap: Information sharing for Medicaid and public health agencies

03.28.25 /

In today's data-driven world, the ability to share information between Medicaid and Public Health Agencies (PHAs) is crucial for efficiently using limited resources to serve both individual patient and population health goals and priorities. Often, states already have the needed technology, but they don’t have the partnerships or workforce infrastructure to leverage existing investments across different agencies.

At BerryDunn, we bring together experts from different disciplines to take on current challenges. Our experience offers states and territories realistic and proven strategies that maximize existing investments to make the broadest impact on a population’s health and well-being.

The following are some planning considerations for uniting Medicaid and public health in accomplishing unique goals with shared resources, and bringing much-needed, sustainable resources to modernize public health systems.

Understand existing data systems

It is essential to understand the context of Medicaid and public health data systems and build solutions based on current realities. For instance, the Medicaid Enterprise System (MES) is a portfolio of systems that support various functions such as beneficiary eligibility, care management, provider enrollment, and often, data analytics to enable value-based care models. In many places, Medicaid is also funding, or has a great stake in, the Health Information Exchange (HIE) system(s), which centralizes clinical health information for access across disparate care settings. Alternatively, PHAs have information systems to support their responsibility to be the source of truth for tracking birth/death records, surveillance, prevention, disease prevalence, and outbreaks. This information collectively informs prevention efforts and helps to monitor and respond to public health threats.

Understand the funding drivers

Medicaid IT systems are funded through a combination of federal and state resources; the federal government provides matching funds from the Centers for Medicare & Medicaid Services (CMS). Federal investments vary by state, but CMS often invests in systems that enable effective Medicaid operations. Some of these CMS-supported systems are typical to Medicaid, such as claims management systems, while others are typical to public health departments, such as immunization registries. Public health information systems receive funding from various federal sources to support efforts like vital records reporting, disease registries, and syndromic surveillance. After decades of underfunding, the Centers for Disease Control and Prevention (CDC) released the Public Health Infrastructure Grant (PHIG), which allocates funding to health departments to support upgrades to technology, training, and staffing for modernized disease detection, prevention, and response. The PHIG-supported infrastructure may include some of the same systems in the Medicaid Enterprise.

Promote data interoperability

One of the main challenges in health information sharing is ensuring that different data systems can communicate with each other. This means adopting standardized data formats and protocols that enable different systems to share and interpret data accurately. Both clinical and public health data sets are defined by clear data standards; however, that does not mean the healthcare community is adhering to these standards consistently. Matters of equity, technical and workforce enhancements, and policy enforcements and incentives all require local collaboration, expert support, and partnerships with leaders aiming for interoperability.

Establish clear governance and policies

Effective health information sharing requires clear governance structures and policies that outline how data will be shared, who will have access, and how privacy will be maintained. Developing a framework that addresses these aspects can help build trust between Medicaid and PHAs, ensuring that data is used responsibly, ethically, and in line with federal and state law.

Draw on proven case studies

Look for proven examples that information sharing can provide valuable insights. Across the nation, MES and PHAs are working together to leverage IT infrastructure to support wide-reaching population health goals. Whether it's ensuring that health records contain accurate death data or public health has real-time laboratory results on disease outbreaks, there is a lot to learn from what is working in the field.

The COVID-19 pandemic proved that health information system infrastructure was not sufficient, and that existing systems were not being used to their capacity. One prevalent example is the lack of use of HIEs to support both Medicaid and PHA data aggregation and sharing needs. HIEs can serve as a clearing house for real-time clinical data directly from the sources of Electronic Health Records (EHRs), laboratory information systems (LIMs), and other community information systems. By identifying shared data needs, Medicaid and PHAs can analyze current information for a variety of foundational use cases that align directly with their strategic goals. Many states and territories have made progress in this area.

Take the first step

Building strong relationships between Medicaid and PHAs is essential if states/territories want to leverage existing IT investments to bolster programs focused on improving health and well-being. Start with finding a champion who is willing to understand the mutual benefits of working together and is a trusted voice with agency leadership. Meet your partners where they are, beginning with what drives them (e.g., environmental pressure, funding sources, existing IT, the mission of their organization). Be consistent and expect that building partnerships that catalyze such transformative impact will take time and energy.

By leveraging existing data systems and fostering a collaborative environment, states/territories can achieve broad information-sharing goals that enhance health outcomes. What do you think about these strategies? Do you have any specific goals or challenges that your state/territory needs help with? Let’s connect!

At BerryDunn, we have hands-on experience working with both Medicaid and PHAs. We can help with strategic planning and coordinating efforts to draft and submit funding requests like APDs, launching projects that benefit both agencies through shared goals and activities. Learn more about our services and contact the Public Health team.

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There’s a good chance that your organization is in the position of needing to do more with less under the strain of staffing constraints and competing initiatives. With fewer resources to work with, you’ll need to be persuasive to get the green light on new enterprise technology initiatives. To do that, you need to present decision makers with well-thought-out and targeted business cases that show your initiative will have impact and will be successful. Yet developing such a business case is no walk in the park. Perhaps because our firm has its roots in New England, we sometimes compare this process to leading a hiking trip into the woods—into the wild. 

Just as in hiking, success in developing a business case for a new initiative boils down to planning, preparation, and applying a few key concepts we’ve learned from our travels. 

Consensus is critical when planning new technology initiatives

Before you can start the hike, everyone has to agree on some fundamentals: 

Who's going? 

Where are we going? 

When do we go and for how long? 

Getting everyone to agree requires clear communication and, yes, even a little salesmanship: “Trust me. The bears aren’t bad this time of year.” The same principle applies in proposing new technology initiatives; making sure everyone has bought into the basic framework of the initiative is critical to success.

Although many hiking trips involve groups of people similar in age, ability, and whereabouts, for your business initiative you need to communicate with diverse groups of colleagues at every level of the organization. Gaining consensus among people who bring a wide variety of skills and perspectives to the project can be complex.

To gain consensus, consider the intended audiences of your message and target the content to what will work for them. It should provide enough information for executive-level stakeholders to quickly understand the initiative and the path forward. It should give people responsible for implementation or who will provide specific skills substantive information to implement the plan. And remember: one of the most common reasons projects struggle to meet their stated objectives (and why some projects never materialize to begin with), is a lack of sponsorship and buy-in. The goal of a business case is to gain buy-in before project initiation, so your sponsors will actively support the project during implementation. 

Set clear goals for your enterprise technology project 

It’s refreshing to take the first steps, to feel that initial sense of freedom as you set off down the trail. Yet few people truly enjoy wandering around aimlessly in the wilderness for an extended period of time. Hikers need goals, like reaching a mountain peak or seeing famous landmarks, or hiking a predetermined number of miles per day. And having a trail guide is key in meeting those goals. 

For a new initiative, clearly define goals and objectives, as well as pain points your organization wishes to address. This is critical to ensuring that the project’s sponsors and implementation team are all on the same page. Identifying specific benefits of completing your initiative can help people keep their “eyes on the prize” when the project feels like an uphill climb.

Timelines provide additional detail and direction—and demonstrate to decision makers that you have considered multiple facets of the project, including any constraints, resource limitations, or scheduling conflicts. Identifying best practices to incorporate throughout the initiative enhances the value of a business case proposition, and positions the organization for success. By leveraging lessons learned on previous projects, and planning for and mitigating risk, the organization will begin to clear the path for a successful endeavor. 

Don’t compromise on the right equipment

Hiking can be an expensive, time-consuming hobby. While the quality of your equipment and the accuracy of your maps are crucial, you can do things with limited resources if you’re careful. Taking the time to research and purchase the right equipment, (like the right hiking boots), keeps your fun expedition from becoming a tortuous slog. 

Similarly, in developing a business case for a new initiative, you need to make sure that you identify the right resources in the right areas. We all live with resource constraints of one sort or another. The process of identifying resources, particularly for funding and staffing the project, will lead to fewer surprises down the path. As many government employees know all too well, it is better to be thorough in the budget planning process than to return to authorizing sources for additional funding while midstream in a project. 

Consider your possible outcomes

You cannot be too singularly focused in the wild; weather conditions change quickly, unexpected opportunities reveal themselves, and being able to adapt quickly is absolutely necessary in order for everyone to come home safely. Sometimes, you should take the trail less traveled, rest in the random lean-to that you and your group stumble upon, or go for a refreshing dip in a lake. By focusing on more than just one single objective, it often leads to more enjoyable, safe, and successful excursions.

This type of outlook is necessary to build a business case for a new initiative. You may need to step back during your initial planning and consider the full impact of the process, including on those outside your organization. For example, you may begin to identify ways in which the initiative could benefit both internal and external stakeholders, and plan to move forward in a slightly new direction. Let’s say you’re building a business case for a new land management and permitting software system. Take time to consider that this system may benefit citizens, contractors, and other organizations that interact with your department. This new perspective can help you strengthen your business case. 

Expect teamwork

A group that doesn’t practice teamwork won’t last long in the wild. In order to facilitate and promote teamwork, it’s important to recognize the skills and contributions of each and every person. Some have a better sense of direction, while some can more easily start campfires. And if you find yourself fortunate enough to be joined by a truly experienced hiker, make sure that you listen to what they have to say.

Doing the hard work to present a business case for a new initiative may feel like a solitary action at times, but it’s not. Most likely, there are other people in your organization who see the value in the initiative. Recognize and utilize their skills in your planning. We also suggest working with an experienced advisor who can leverage best practices and lessons learned from similar projects. Their experience will help you anticipate potential resistance and develop and articulate the mitigation strategies necessary to gain support for your initiative.

If you have thoughts, concerns, or questions, contact our team. We love to discuss the potential and pitfalls of new initiatives, and can help prepare you to head out into the wild. We’d love to hear any parallels with hiking and wilderness adventuring that you have as well. Let us know! 

BerryDunn’s local government consulting team has the experience to lead technology planning initiatives and develop actionable plans that help you think strategically and improve service delivery. We partner with you, maintaining flexibility and open lines of communication to help ensure that your team has the resources it needs.

Our team has broad and deep experience partnering with local government clients across the country to modernize technology-based business transformation projects and the decision-making and planning efforts. Our expertise includes software system assessments/planning/procurement and implementation project management; operational, management, and staffing assessments; information security; cost allocation studies; and data management.  

Article
Into the wild: Building a business case for a new enterprise technology project

Read this if you are planning for, or are in the process of implementing a new software solution.

User Acceptance Testing (UAT) is more than just another step in the implementation of a software solution. It can verify system functionality, increase the opportunity for a successful project, and create additional training opportunities for your team to adapt to the new software quickly. Independent verification through a structured user acceptance plan is essential for a smooth transition from a development environment to a production environment. 

Verification of functionality

The primary purpose of UAT is to verify that a system is ready to go live. Much of UAT is like performing a pre-flight checklist on an aircraft. Wings... check, engines... check, tires... check. A structured approach to UAT can verify that everything is working prior to rolling out a new software system for everyone to use. 

To hold vendors accountable for their contractual obligations, we recommend an agency test each functional and technical requirement identified in the statement of work portion of their contract. 

It is also recommended that the agency verify the functional and technical requirements that the vendor replied positivity to in the RFP for the system you are implementing. 

Easing the transition to a new software

Operational change management (OCM) is a term that describes a methodology for making the switch to a new software solution. Think of implementing a new software solution like learning a new language. For some employees, the legacy software solution is the only way they know how to do their job. Like learning a new language, changing the way business and learning a new software can be a challenging and scary task. The benefits outweigh the anxiety associated with learning a new language. You can communicate with a broader group of people, and maybe even travel the world! This is also true for learning a new software solution; there are new and exciting ways to perform your job.

Throughout all organizations there will be some employees resistant to change. Getting those employees involved in UAT can help. By involving them in testing the new system and providing feedback prior to implementation, they will feel ownership and be less likely to resist the change. In our experience, some of the most resistant employees, once involved in the process, become the biggest champions of the new system.  

Training and testing for better results

On top of the OCM and verification benefits a structured UAT can accomplish, UAT can be a great training opportunity. An agency needs to be able to perform actions of the tested functionality. For example, if an agency is testing a software’s ability to import a document, then a tester needs to be trained on how to do that task. By performing this task, the tester learns how to login to the software, navigate the software, and perform tasks that the end user will be accomplishing in their daily use of the new software. 

Effective UAT and change management

We have observed agencies that have installed software that was either not fully configured or the final product was not what was expected when the project started. The only way to know that software works how you want is to test it using business-driven scenarios. BerryDunn has developed a UAT process, customizable to each client, which includes a UAT tracking tool. This process and related tool helps to ensure that we inspect each item and develop steps to resolve issues when the software doesn’t function as expected. 

We also incorporate change management into all aspects of a project and find that the UAT process is the optimal time to do so. Following established and proven approaches for change management during UAT is another opportunity to optimize implementation of a new software solution. 

By building a structured approach to UAT, you can enjoy additional benefits, as additional training and OCM benefits can make the difference between forming a positive or a negative reaction to the new software. By conducting a structured and thorough UAT, you can help your users gain confidence in the process, and increase adoption of the new software. 

Please contact the team if you have specific questions relating to your specific needs, or to see how we can help your agency validate the new system’s functionality and reduce resistance to the software. We’re here to help.   
 

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User Acceptance Testing: A plan for successful software implementation

The BerryDunn Recovery Advisory Team has compiled this guide to COVID-19 consulting resources for state and local government agencies and higher education institutions.

We have provided a list of our consulting services related to data analysis, CARES Act funding and procurement, and legislation and policy implementation. Many of these services can be procured via the NASPO ValuePoint Procurement Acquisition Support Services contract.

READ THE GUIDE NOW

We're here to help.
If you have any questions, please contact us at info@berrydunn.com

Article
COVID-19 consulting resources

Read this if your organization, business, or institution has leases and you’ve been eagerly awaiting and planning for the implementation of the new lease standards.

Ready? Set? Not yet. As we have prepared for and experienced delays related to Financial Accounting Standards Board (FASB) Accounting Standards Codification Topic 842, Leases, we thought the time had finally come for implementation. With the challenges that COVID-19 has brought to everyone, the FASB recognizes the significant impact COVID-19 has brought to commercial businesses and not-for-profits and is proposing a one-year delay in implementation, as described in this article posted to the Journal of Accountancy: FASB effective date delay proposals to include private company lease accounting.

But what about lease concessions? We all recognize many lessors are making concessions due to the pandemic. Under current guidance in Topics 840 and 842, changes to lease contracts that were not included in the original lease are generally accounted for as lease modifications and, therefore, a separate contract. This would require remeasurement of the new lease contract and related right-of-use asset. FASB recognized this issue and has published a FASB Staff Questions and Answers (Q&A) Document,  Topic 842 and Topic 840: Accounting for Lease Concessions Related to the Effects of the COVID-19 Pandemic. Under this new guidance, if lease concessions are made relating to COVID-19, entities do not need to analyze each contract to determine if a new contract has been entered into, and will have the option to apply, or not to apply, the lease modification provisions of Topics 840 and 842.

Implementation of the lease accounting standard will most likely be delayed for Governmental Accounting Standards Board (GASB) entities as well. On April 15, 2020, the GASB issued an exposure draft that would delay most GASB statements and implementation guides due to be implemented for fiscal years 2019 and later. Most notably, this includes Statement 84, Fiduciary Activities, and Statement 87, Leases. Comments on the proposal will be accepted through April 30, and the board plans to consider a final statement for issuance on May 8. More information may be found in this article from the Journal of Accountancy: GASB proposes postponing effective dates due to pandemic.

More information

Whether you are a FASB or GASB entity, you can expect a delay in the implementation of the lease standard. If you have questions, please contact a member of our financial statement audit team. For other COVID-19 related resources, please refer to BerryDunn’s COVID-19 Resources Page.

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FASB and GASB news: Postponement of the lease accounting standards

Read this if you work at a public health department and would like a brief summary of how you can maximize funding and meet new federal requirements.

Unpacking the trillions

In response to the COVID-19 pandemic, several pieces of legislation were passed by congress and signed into law. The three bills, H.R. 6074 Coronavirus Preparedness and Response Supplemental Appropriations Act, H.R. 6201 Families First Coronavirus Response Act, and H.R. 748 Coronavirus Aid, Relief, and Economic Security (CARES) Act, have provided funding for various federal agencies with different roles in responding to the crisis. Because of the urgency required, much of the guidance for use of funds and reporting requirements were released after passage of the bills or have yet to be released.

Here is a brief timeline and summary of the acts:

Implication and next steps for state public health departments

While little guidance has been provided for how state public health departments should prepare to access federal funds, BerryDunn will continue to monitor and release updates as they become available. 

While at this point HR 6074 has the greatest implications for public health departments, here are some actions that states should take now for their public health programs from the recent legislation:

  1. H.R. 6074: Provides appropriations to the CDC to be allocated to states for COVID-19 expenses.
    • To ensure maximum funding, prepare a spend plan to submit to CDC.
    • To ensure compliance, provide CDC with copies or access to COVID-19 data collected with these funds.
    • To maximize the impact of new funding, develop a COVID-19 community intervention plan.
    • To support streamlined operations, submit revised work plans to CDC.
    • To prevent missed deadlines, submit any requests for deadline extensions to the CDC.
  2. H.R. 6201: Provides guidance specific to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs.
    • To encourage social distancing and loosen administrative requirements, seek waivers through the USDA’s Food and Nutrition Service (FNS).
    • To ensure compliance, prepare to submit a report summarizing the use of waivers on population outcomes by March 2021.
  3. H.R. 748: Allocates $150 billion to a coronavirus relief fund for state, local, and tribal governments.
  • To secure funding, monitor the US Department of Health & Human Services (HHS) for guidance on using funds for:
    • Coronavirus prevention and preparation
    • Tools to build health data infrastructure
    • COVID-19 Public Health Emergency expenses
    • Developing countermeasures and vaccines for coronavirus
    • Telehealth and rural health activities
       
  • To ensure HIPAA compliance when sharing protected patient health information, monitor the US Department of Health & Human Services (HHS) for guidance.

For more information

For specific issues your agency has, or if you have other questions, please contact us. We’re here to help. 

Article
COVID-19 laws and their impact on state public health agencies

Read this if you would like a refresher of common-sense approaches to protect against fraud while working remotely.

Coronavirus (COVID-19) has imposed many challenges upon us physically, mentally, and financially. Directly or indirectly, we all are affected by the outbreak of this life-threatening disease. Anxious times like this provide perfect opportunities for fraudsters. The fraud triangle is a model commonly used to explain the three components that may cause someone to commit fraud when they occur together:

  1. Financial pressure/motivation 
    In March 2020, the unemployment rate increased by 0.9 percent to 4.4 percent, and the number of unemployed persons rose by 1.4 million to 7.1 million.
  2. Perceived opportunity to commit fraud 
    Many people are online all day, providing more opportunities for internet crime. People are also desperate for something, from masks and hand sanitizers to coronavirus immunization and cures, which do not yet exist. 
  3. Rationalization 
    People use their physical, mental, or financial hardship to justify their unethical behaviors.

To combat the increasing coronavirus-related fraud and crime, the Department of Justice (DOJ) launched a national coronavirus fraud task force on March 23, 2020. It focuses on the detection, investigation, and prosecution of fraudulent activity, hoarding, and price gouging related to medical resources needed to respond to the coronavirus. US attorney’s offices are also forming local task forces where federal, state, and local law enforcement work together to combat the coronavirus related crimes. Things are changing fast, and the DOJ has daily updates on the task force activities. 

Increased awareness for increased threats

Given the increase in fraudulent activity during the COVID-19 outbreak, it’s important for employees now working from home to be aware of ways to protect themselves and their companies and prevent the spread of fraud. Here are some of the top COVID-19-related fraud schemes to be aware of. 

  • Phishing emails regarding virus information, general financial relief, stimulus payments, and airline carrier refunds
  • Fake charities requesting donations for illegitimate or non-existent organizations 
  • Supply scams including fake shops, websites, social media accounts, and email addresses claiming to sell supplies in high demand but then never providing the supplies and keeping the money 
  • Website and app scams that share COVID-19 related information and then insert malware that could compromise the device and your personal information
  • Price gouging and hoarding of scarce products
  • Robocalls or scammers asking for personal information or selling of testing, cures, and essential equipment
  • Zoom bombing and teleconference hacking

If you have encountered suspicious activity listed above, please report it to the FBI’s Internet Crime Complaint Center.

Staying vigilant

To protect yourself from these threats, remember to use proper security measures and follow these tips provided by the Federal Bureau of Investigation (FBI) and DOJ:

  • Verify the identity of the company, charity, or individual that attempts to contact you in regards to COVID-19.
  • Do not send money to any business, charity, or individual requesting payments or donations in cash, by wire transfer, gift card, or through the mail. 
  • Understand the features of your teleconference platform and utilize private meetings with a unique code or password that is not shared publicly.
  • Do not open attachments or click links within emails from senders you do not recognize.
  • Do not provide your username, password, date of birth, social security number, insurance information, financial data, or other personal information in response to an email or robocall.
  • Always verify the web address of legitimate websites and manually type them into your browser.
  • Check for misspellings or wrong domains within a link (for example, an address that should end in a ".gov" ends in .com" instead).

Stay aware, and stay informed. If you have specific concerns or questions, or would like more information, please contact our team. We’re here to help.
 

Article
COVID-19 and fraud―a security measures refresher

Editor’s note: If you are a state government CFO, CIO, project or program manager, this blog is for you. 

This is the second blog post in the blog series: “Procuring Agile vs. Non-Agile Service”. Read the first blog. This blog post demonstrates the differences in Stage 1: Plan Project in the five stages of procuring agile vs. non-agile services.

Overview of Procurement Process for Agile vs. Non-Agile IT Services

What is important to consider in agile procurement?

Here are some questions that can help focus the planning for procurement of IT services for agile vs. non-agile projects.

 

Plan Project Considerations for Agile vs. Non-Agile IT Services

Why are these considerations important?

When you procure agile IT services, you can define the scope of your procurement around a vision of what your organization intends to become, as opposed to being restricted to an end-date for a final delivery.

In an agile project, you get results iteratively; this allows you to constantly reassess requirements throughout the project, including the project plan, the guiding principles, and the project schedule. Your planning is not restricted to considering the effect of one big result at the end of the project schedule. Instead, your plan allows for sequencing of changes and improvements that best reflect the outcomes and priorities your organization needs. 

Since planning impacts the people-aspect of your strategy, it is important to consider how various teams and stakeholders will provide input, and how you will make ongoing communication updates throughout the project. With an agile procurement project, your culture will shift, and you will need a different approach to planning, scheduling, communicating, and risk management. You need to communicate daily, allowing for reviewing and adjusting priorities and plans to meet project needs. 

How do you act on these considerations?

A successful procurement plan of agile IT services should include the following steps:

  1. Develop a project charter and guiding principles for the procurement that reflect a vision of how your organization’s teams will work together in the future
  2. Create a communication plan that includes the definition of project success and communicates project approach
  3. Be transparent about the development strategy, and outline how iterations are based on user needs, that features will be re-prioritized on an ongoing basis, and that users, customers, and stakeholders are needed to help define requirements and expected outcomes
  4. Provide agile training to your management, procurement, and program operation teams to help them accept and understand the project will present deliverables in iterations, to include needed features, functionality and working products
  5. Develop requirements for the scope of work that align with services and outcomes you want, rather than documented statements that merely map to your current processes 

What’s next? 

Now that you have gained insight into the approach to planning an agile project, consider how you may put this first stage into practice in your organization. Stay tuned for guidance on how to execute the second stage of the procurement process—how to draft the RFP. Our intention is that, following this series, your organization will better understand how to successfully procure and implement agile services. If you have questions or comments, please contact our team.
 

Article
Plan agile projects: Stage 1