DevOps: Advance software solutions and improve outcomes

Read this if you work within a State Medicaid Agency (SMA). This is the fifth and final article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC) 2024. Prior articles highlighted industry MES trends, the value of the CMS and SMA MES partnership, the roles outcomes play in supporting enterprises, how SMAs can embrace Artificial Intelligence (AI), and further support their teams in achieving organizational excellence. 

If you attended the Medicaid Enterprise Systems Conference (MESC) back in August, you likely had the opportunity to join one of the many exciting workshops on day one of the conference. One of those workshops was focused on leading people through change. Facilitators guided attendees through an interactive exercise that replicated the chaos and confusion experienced during change. This exercise quickly became a frequent topic of conversation among MESC attendees because it demonstrated the importance of building and executing a plan that attends to communication, education, and motivation during times of change. The workshop, along with a handful of sessions throughout the week, highlighted the importance of having a people-focused strategy, and the resulting power from doing so. These refreshing conference topics gave meaningful insight into the pain points of invested MES parties, as well as practical solutions to help support them. 

So how can we all maintain focus on the people? 

• Be in tune with the energy (positive or negative) and engagement (high or low) of the group. If you’re not, find someone who is, and then build and maintain high energy and positive engagement through open communication, milestone celebration, collaboration, support, and recognition.  
• Identify resistance and address it quickly. Ask people about their concerns to help you understand their resistance. 
• Tactfully involve resistors in helping solve the problems they see. 
• Remember your "why" and find the reasoning. Why are we here? Why do we do what we do, and why are we changing? What are the benefits associated with this change? 
• Focus on the areas where you have influence. 
• Be sure team members have clarity and are committed to the project and its approach before jumping in. 
• Identify how you as a project team will be flexible: Flexibility is knowing the approach that was previously successful might not work the next time. 
• Collaborate with invested parties to identify and integrate lessons learned from prior efforts into existing ones. 
• Strategically identify and leverage your change catalysts as influencers to early adopters.  
• Consider how to contain and support the ‘fervent resistors’ to prevent increasing the resistance of the late adopters. 
• When leading, designing, and driving change, create a strategy and plan that pays attention to communication, education, and motivation. 

Other insights to help support your team, help ensure people come first, and help achieve success in your multimodule multivendor environment include the following: 

What’s Your North Star? Establish a vision that is the product of your agency and the people it serves. To establish a vision, SMAs should engage leadership and other invested parties to identify and align on long-term goals. This typically involves conducting a situational analysis (i.e., SWOT), clarifying the mission and values, and facilitating collaborative workshops to generate ideas on the agency’s vision. Once established, speak it, maintain it, and discuss how you’re achieving it. If you really want to be an all-star, identify your vision’s goals, outcomes, and metrics…then track against it! 

Workload: Be mindful of your SMA capacity. Measuring an organization’s capacity involves assessing its ability to deliver services, manage resources, and achieve goals. Key areas to evaluate include human resources, operational efficiency, technology, financial health, and strategic alignment. Tools like capacity assessments, KPIs, and process analysis help identify gaps and measure performance, while regular evaluation of these areas helps ensure the organization can be well positioned for growth, resilience, and effective decision-making.  

Portfolio, Program, and Project Management: Establish consistent processes (risk and issue management, change request process, etc.) across all invested parties (i.e., vendors and staff) and educate them during onboarding. Typically, MES organizational layers like a portfolio, program, and/or project management office can help establish, implement, and maintain these processes. Consistent processes are vital for ensuring the successful execution and governance of projects across an SMA. This uniformity not only reduces risks and operational inefficiencies but also supports scalability and continuous improvement, ensuring that the portfolio of initiatives delivers maximum value to the organization. 

Governance: Governance is critical for MES projects within an SMA involving multiple vendors because it ensures accountability, alignment, and oversight across all project activities. A strong governance framework provides clear decision-making structures, establishes performance metrics, and enforces compliance with state and federal regulations. This helps manage risks, streamlines communication, and ensures that vendors work collaboratively toward the SMA’s strategic goals, ultimately improving project outcomes and service delivery for Medicaid beneficiaries. 

Organizational Change Management (OCM): OCM is crucial for SMA initiatives (technology or otherwise) as it helps ensure that the change brought about by an initiative aligns with the needs and concerns of the people impacted by the change. By prioritizing activities such as communication, training, and support, OCM helps ease the transition for invested parties, facilitating buy-in and reducing resistance. This focus on the human element not only enhances user adoption of new programs, policies, systems, and processes but also promotes a positive organizational culture, ensuring that the implementation leads to sustainable improvements in service delivery and overall agency effectiveness. 

Collaboration: Effective collaboration within an SMA for MES projects involves establishing clear roles and responsibilities, using centralized communication tools, and following standardized project management practices. Engaging invested parties early, focusing on data-driven decision-making, and fostering transparency are key to helping ensure alignment and continuous improvement.  

Timely Issue Identification, Resolution, and Communication: Early identification allows for timely resolution, minimizes disruptions, and helps maintain project momentum. It also fosters transparency and trust within teams, ensuring that all invested parties are informed and can collaborate on effective solutions. Swift issue escalation promotes better decision-making and reduces the risk of missed deadlines or budget overruns. Be sure to also communicate the root cause and solution in place to address issues in order to further foster buy-in and credibility.  

Leading through change isn’t just about managing tasks—it’s about guiding people. By focusing on communication, education, and motivation, we help ensure our teams are not only prepared for change but empowered by it. As we navigate the complexities of our work, let’s remember that real progress comes from putting people first, fostering collaboration, and maintaining a clear vision. With these principles at the forefront, we’re not just managing change—we’re driving meaningful transformation. 

Although MESC 2024 has come to a close, conference presentations, innovative discussions, and the work of the industry’s brightest minds live on. Conferences like MESC and the upcoming Information Technology Solutions Management for Human Services (ISM) reaffirm the importance of collaboration, adaptability, and putting people first in our journey toward modernizing HHS programs and the technology needed to support them. As we move ahead, let's remain focused on building strong relationships, staying adaptable in the face of change, and continuously aligning our efforts with the ultimate goal: Better serving the country’s most vulnerable populations. Together, through thoughtful leadership and strategic partnership, we can transform challenges into opportunities for meaningful impact. 

Previous articles in this series: 

CMS is your enterprise partner: Are you leaning in yet?

MITA 4.0, APDs, and more: Clearer guidance and helpful templates are coming!

Medicaid outcomes, measures, and metrics are here to stay

Practical Approaches to Using Artificial Intelligence in State Medicaid Agencies

Read this if you work within a State Medicaid Agency (SMA). This is the fourth article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC) 2024. Prior articles highlighted industry trends, the value of the CMS and SMA MES partnership, and forthcoming guidance on APDs, SMC, and MITA 4.0, while future articles will discuss how SMAs can further support their teams in achieving organizational excellence.

Artificial Intelligence (AI) continues to dominate tech innovation headlines and Medicaid industry partners continue to express both fear and excitement over its potential to tactically support the enterprise. State Medicaid Agencies (SMAs) and their industry partners have been tactfully integrating Artificial Intelligence—whether generative, predictive, analytical, automated, or assisted—into Medicaid discussions and initiatives...and generating positive results!

Below are a few examples of SMAs testing the AI waters and getting favorable results:

• Tennessee is using AI to rapidly locate policy answers to address constituent questions and expedite eligibility determinations.
• Kentucky is using a chat knowledge bot to help eligibility workers search for policy and process information.
• New York is leveraging docAI to match EOBs to claims and identify potential mismatches for human review.
• Louisiana is using a chatbot for non-MAGI call centers to answer basic questions and allow customer service representatives to focus on other work and calls. (Spoiler: Constituents love it!)
• Wisconsin is using a chatbot to examine existing policies and help team members find answers needed to support their responsibilities.

At the Medicaid Enterprise Systems Conference (MESC) in August, SMAs and industry leaders also discussed and provided advice for interested parties looking to start the AI conversation:

• Identify clear objectives for AI—through defined use cases and measurable goals—to help ensure AI initiatives align with your agency’s overall mission, vision, and goals.
• Build a strong data foundation and clear boundaries through data quality, governance, and interoperability.
• Start small with pilot projects.
• Invest in upskilling staff and establish teams to help them understand AI technologies, how to work with them, and how to interpret AI-driven insights. Don’t forget to test your AI technologies!
• Draft and implement agency policies and protocols to monitor AI systems, create transparency, and help ensure ethical and responsible AI use.
• Collaborate with federal and industry partners to share knowledge, resources, and best practices.
• Focus on the scalability of solutions, the need to continuously improve AI technologies, and how teams are using them.

As an industry leader who is partnering with SMAs nationwide, BerryDunn is often called upon to be at the forefront of helping SMAs design innovative solutions for their Medicaid programs. AI provides SMAs the unique opportunity to address operational challenges as well as existing business processes in areas such as program integrity, care management, member engagement, and data analytics and reporting. In addition to the great points industry leaders shared at MESC, below are some additional considerations for Medicaid innovators looking to get started:

Understand the opportunities for AI: Each Medicaid program is unique, and understanding where there may be opportunities for efficiency or enhanced effectiveness is a good first step to identifying where AI may be able to support your program. Typically, the areas of program integrity, provider enrollment, member enrollment, care management, and data analytics and reporting are some of the more typical business areas where AI-related opportunities may exist. An SMA’s Medicaid Information Technology Architecture (MITA) State Self-Assessment (SSA) may be a great document to reference when looking for those opportunities for AI.

Assess the current state: Assessing the current state of an SMA does not just entail focusing on the program’s policy- or technology-related needs. It also entails understanding the organizational capacity for change and its understanding of AI. Change and AI have a tendency to bring about excitement and apprehension, and understanding your SMA's readiness for change and AI is essential part of gaining SMA buy-in.

Define your AI use cases: As an output from your analysis of those opportunities for AI and your assessment of the current state, consider those areas where AI could make the most immediate impact. Maybe it’s in program integrity where predictive analytics and AI-based fraud detection could identify anomalies in billing, or maybe it’s in care management where assistance identifying high-risk patients is needed. As mentioned earlier, start small!

Build a cross-functional team: Successful AI requires collaboration across the agency and more specifically within those areas impacted by your use cases. Typically, AI teams are comprised of a sponsor, more technical resources familiar with the SMA’s technology and infrastructure, your business leads, and AI experts. Your federal partners are also an invaluable resource for you on your AI journey.

Invest in data governance and infrastructure: AI thrives in high-quality data environments, so SMAs will need data governance and its supporting infrastructure to help ensure AI solutions can be effective. Prioritize clean, standardized, and accessible data, and ensure appropriate safeguards (i.e. policy) are in place to support AI usage.

Plan for long-term AI integration (and change!): AI is here to stay. Investing in your agency’s AI roadmap is one effective way to help establish an AI plan and infrastructure that can improve operational efficiency, enhance program effectiveness, and enhance rates of adoption.

By starting with a focused, methodical approach, SMAs can leverage AI to enhance service delivery, improve operational efficiency, and better serve their constituents. Embracing AI is an existing SMA challenge. Let’s continue the conversation on how we can help today!

Previous articles in this series: 

CMS is your enterprise partner: Are you leaning in yet?

MITA 4.0, APDs, and more: Clearer guidance and helpful templates are coming!

Medicaid outcomes, measures, and metrics are here to stay

Read this if you work within a State Medicaid Agency (SMA). This is the third article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC) 2024. A prior article highlighted industry MES trends and the value of the CMS and SMA MES partnership, while future articles will discuss how SMAs can embrace Artificial Intelligence (AI), and how SMAs can further support their teams in achieving organizational excellence.

If there’s one thing that was clear at the recent Medicaid Enterprise Systems Conference (MESC) in Louisville, it is that CMS is focused on meaningful enterprise planning, meaningful outcome definitions, and meaningful data from State Medicaid Agencies (SMAs) to illustrate trends throughout every phase of the IT life cycle and the benefit to Medicaid beneficiaries.

In support of this theme, the Data Systems group (DSG) Division of State Systems (DSS) Director Eugene Gabrielov has also proclaimed this to be the “year of metrics,” and strongly encouraged SMAs to fulfill their obligation to be actively reporting on the outcomes and metrics for all solutions that have received enhanced Federal Financial Participation (FFP).  

CMS also continues to make operational reporting requirements a part of everyday conversations and remains available to SMAs for support in their enterprise planning and outcome management efforts. The partnerships between SMAs, CMS, and other industry partners are more frequently leading to discussions on how to make operational outcomes more meaningful. More often than not, CMS is questioning SMAs about the value attained from SMA outcomes and encouraging them to revisit outcomes to help ensure they are assisting in the management of the enterprise.   

At MESC this year, CMS also reiterated key operational reporting requirements and underscored the importance of SMA adoption of outcomes and adherence to their related reporting requirements:  

• Any Medicaid solution receiving enhanced FFP for M&O should be submitting metrics to CMS.
• Although a draft ORW is required for the Streamlined Modular Certification (SMC) Operational Readiness Review (ORR), SMAs should begin submitting ORWs to CMS and posting ORW information to the Box subsequent to the ORR.   
• In alignment with requirements for SMC-certified solutions, legacy systems must submit ongoing ORWs with data for each metric at least annually; however, CMS encourages this data be produced, reviewed, acted upon (if necessary), and submitted to CMS monthly.  
• Annual OAPD submissions should include 12 months of data and be submitted by the annual OAPD submission deadline (typically in the month of August if not sooner).  
• ORWs submitted with an Operations Advanced Planning Document (OAPD) are expected to include 12 months of data.  

For additional details on operational reporting requirements, refer to this CMCS informational bulletin, the ORW template, the ORW procedure manual, and metrics-related FAQs.  

As SMAs embark on MES journeys and are developing an APD, building an RFP, or merely defining a business challenge, CMS encourages SMAs to reach out to each other, CMS, or the vendor community for support with outcomes definition, adoption, and management. Similarly, several innovative portfolio-management-focused SMAs like Tennessee and Vermont are also looking to technology and supporting services, such as our own HHS investment management suite, tHHS, to plan for change, manage their enterprise, and fulfill federal partners' guidance. These solutions can provide you with valuable insight into the industry data needed to inform strategic planning and related procurement initiatives while also helping you manage the implementation and operations phases of your enterprise.  

The focus on outcomes, measures, and metrics is not a passing trend; it’s the foundation for effective enterprise planning and outcomes management in the Medicaid space. CMS’s emphasis on meaningful data and transparency underscores the need for SMAs to embrace these practices and integrate them into their IT planning life cycle. By leaning on each other, collaborating closely with CMS, and leveraging innovative technologies, SMAs can not only meet these requirements but also drive significant improvements in service delivery and beneficiary outcomes.

As we move forward, let's commit to a metrics-driven approach that helps ensure every decision, every investment, and every effort aligns with the ultimate goal of enhancing the lives of those we serve.  

Previous articles in this series:

• MITA 4.0, APDs, and more: Clearer guidance and helpful templates are coming!
• CMS is your enterprise partner: Are you leaning in yet?

Read this if you work within a State Medicaid Agency (SMA). This is the second article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC). A prior article highlighted industry MES trends and the value of the CMS and SMA MES partnership, while future articles will include guidance on SMA MES outcomes, how SMAs can embrace Artificial Intelligence (AI), and how SMAs can further support their teams in achieving organizational excellence.

At MESC in Louisville this year, CMS announced it would be publishing new Advanced Planning Document (APD) and testing guidance as well as seven required templates. Through these publications, CMS is acknowledging feedback and lessons learned from SMAs and vendors while also enabling standardization and connections across Medicaid Enterprise Systems (MES). This guidance is also sure to help further data standardization and MES integration within SMAs.

The seven required MES templates, identified below, are coming to you in the very near future:

1. MES APD: Used for Planning-Advanced Planning Documents (PAPDs), Implementation Advanced Planning Documents (IAPDs), Advanced Planning Document Updates (APDUs), and as-needed submissions. Used for both Medicaid Management Information System (MMIS) and Eligibility and Enrollment (E&E) APD submissions. 
2. MES Operations Advanced Planning Document (OAPD): Used to seek funding for system maintenance and operating costs.
3. Analysis of Alternatives (AOA) Template: Used to standardize submission of the CFR-required statement of alternative considerations detailed in the IAPD and other APDs (as applicable). CMS also noted that AOAs and reuse plans serve as a compelling factor in determining CMS support of SMA FFP requirements.
4. MES Medicaid Detailed Budget Table (MDBT): Used to provide a structure for submitting required detailed budget data within an APD.
5. Operations Reporting Workbook (ORW): Used for documenting metric definitions and values that show you are meeting applicable outcomes and benefits to Medicaid.
6. Certification Eligibility Triage Form: Used to determine whether Streamlined Modular Certification (SMC) applies to the project.
7. Monthly Project Status Report Template: Used to monitor, oversee, and manage risks associated with achieving APD-established project outcomes.

CMS also highlighted the next evolution of MITA 4.0, which promises to reduce the burden on SMAs in fulfilling their MITA obligations and aids in streamlining strategic planning efforts and implementation, as well as maintenance and operations (M&O) reporting. Learn more about how Alejandra Johnson, technical director of the Division of State Systems at CMS, and the MITA industry workgroup are moving MITA forward.

Keeping with the theme of furthering CMS and SMA’s partnership, two CMS state officers (SOs)—Jessica Dunlap and Dion Summerville—provided attendees with insight into the day in the life of a CMS SO. They highlighted the SO team structure, operational statistics, and some notable do’s and don’ts. Below are some of my personal favorites:

• The SOs are organized into five color teams and an operations team that spans all 56 SMAs.
• SOs are primarily responsible for reviewing procurement/APD documentation, conducting certification reviews, serving as a strategic partner for the SMA, participating in workgroups, and providing meeting support and technical assistance for SMAs.
• In FY2023, CMS SOs reviewed more than 675 APDs, 500 contracts, 90 SOWs and RFPs, and one audit. That’s a whole lot of documents!
• Other notable APD do’s and don’ts:
  • Do schedule meetings with your SO prior to APD submission.
  • Do clearly define outcomes and metrics.
  • Do forecast and schedule future APD submissions.
  • Do list all contracts and contract costs in the contractor resource section.
  • Do begin cost allocation discussions early.
  • Don’t forget your vendor and personnel resource statements.
  • Don’t forget to include procurement, testing, and implementation schedules.
  • Don’t forget that CMS has a 60-day review window.
  • Don’t skimp on writing your alternatives analysis.

CMS also highlighted the ongoing importance of SMAs building reuse plans into their APDs and announced forthcoming guidance—a testing framework—for SMAs to use in support of their modernization efforts.

CMS’s commitment to providing clearer guidance and standardized templates marks a pivotal step toward simplifying and enhancing SMA MES operations. CMS listened to the needs of SMAs and vendors and is fostering greater connectedness across the Medicaid landscape. As we prepare to adopt these templates and guidance, the message is clear: Success lies in collaboration, standardization, and proactive engagement with CMS. Let’s embrace these changes and continue building stronger, more efficient systems for those we serve.

Please contact our Medicaid consulting team if you have any questions or would like to learn more. We're here to help.

Read this if you work within a State Medicaid Agency (SMA). This is the first article in a series of articles published in follow-up to the Medicaid Enterprise Systems Conference (MESC). Future article topics will speak to guidance shared at MESC on MITA 4.0, Advanced Planning Documents (APD), forthcoming templates, Artificial Intelligence (AI) in Medicaid, and operational reporting requirements.

If you haven’t already embraced the Centers for Medicare and Medicaid Services (CMS) as a partner for your SMA Medicaid Enterprise System (MES), now is a great time to start. CMS was out in full force at the Medicaid Enterprise Systems Conference (MESC), highlighting trends across the MES space, bringing policy and regulatory changes to the front of conversations, and showcasing SMA collaboration and reuse at every turn. Across sessions and collaborative workshops, CMS clarified the value it seeks from MITA 4.0, the steps taken to move it forward, and the industry partners committed to making it a reality. Most evident was CMS’s message about the value that can come from engaging CMS and SMA state officers (SOs) early and often in your enterprise planning, implementation, and operations discussions.

In true partner fashion, CMS highlighted several trends in Medicaid to help inform SMAs’ MES journeys:

• Certain module enhancements may no longer require streamlined modular certification and can be eligible for enhanced funding (i.e., Health Information Exchange [HIE], prescription drug monitoring program [PDMP], and data warehouse [DW] modules).
• SMAs continue to focus on a single module or vendor at a time as opposed to multiple modules for the same vendor.
• SMAs continue to implement cloud-based end-to-end solutions as replacements for legacy Medicaid Management Information System (MMIS) modules.
• SMAs are asking to forego Operational Readiness Reviews (ORRs) altogether due to testing delays and skip straight to requesting certification. CMS is asking SMAs to stop requesting ORRs be skipped and instead prioritize making sure the solution’s testing is comprehensive, of quality, and producing results that instill confidence in the solution’s ability to fulfill your program needs.
• During CMS site visits, SMAs shared concerns regarding procurement, vendor management, and public health emergency (PHE) unwinding as they relate to various MMIS projects.
• SMAs are continuing to replace legacy systems, and the industry should expect to see more MMIS module certifications as states and territories shift to new solutions.

Lastly—and for the first time at MESC—CMS presented a summary and synthesis of regulatory changes that highlighted each regulatory requirement’s timing so that it could serve as an input into SMA efforts. This is an incredibly valuable reference for all SMAs and is available via outreach to your SO!

Partnering with CMS is not optional—it's essential. CMS’s presence and insights at MESC underscored the importance of early and ongoing collaboration. By aligning with CMS guidance and leveraging its expertise, SMAs can navigate MES complexities more effectively. Whether it's embracing MITA 4.0, staying informed on regulatory changes, or integrating new technologies, the path to success lies in a strong partnership with CMS. Let’s continue to engage, collaborate, and build a future where our collective efforts drive meaningful outcomes for the Medicaid community.

Please contact our Medicaid team if you have any questions or would like to learn more. We're here to help.

This October, my colleagues and I attended the National Association of Health Data Organizations (NAHDO) annual meeting in Park City, Utah. NAHDO is a national non-profit membership and educational association dedicated to improving healthcare data collection and use. NAHDO is also a co-founder and member of the All-Payer Claims Database (APCD) Council, which provides leadership and technical assistance to states implementing APCDs. For more on the history of NAHDO, click here.

This year’s conference centered on balancing transparency, privacy, and quality in an age of enhanced reporting on public health information. As a follow-up to the annual meeting, I wanted to share with you some of the key takeaways:

1. Stakeholder engagement is key to achieving increased data transparency. As state agencies, hospitals, researchers, and other health data representatives embark on data transparency-related initiatives, representatives from Colorado, Maine, New Hampshire, and Washington made clear the importance of having the right stakeholders involved from the start. To NAHDO attendees these stakeholders include attorneys, providers, members, state agency representatives, legislators, payers, and others with the subject matter expertise and experience to integrate and publicly share health information data.
2. Collaboration maximizes cost transparency. Collecting cost-related information from providers, and making the information accessible to health data consumers, remains a difficult task for many organizations. Although several states have worked diligently with legislators to mandate that providers supply cost-related information to state health agencies, several other states have partnered with their member, provider, and insurance communities to form work groups that collaborate in the name of making healthcare more accessible and affordable.
3. If you build it, they may not come. Building treasure troves of information for health data consumers is only beneficial if the consumers know the information exists, and are interested in using it. To help spread the word about new web-based platforms and/or tools, organizations across the nation are leveraging creative marketing strategies via Google AdWords and Facebook. Colleagues from Colorado’s Shop for Care, Maine’s CompareMaine, New Hampshire’s HealthCost, New York’s FAIR Health, and Washington’s HealthCareCompare shared their successes and challenges in making the public aware of critical healthcare information. In support of this takeaway, Andrea Clark, BerryDunn’s Senior Analytics Manager, joined colleagues from the Center for Improving Value in Health Care, Washington State, and FAIR Health to speak about BerryDunn’s work helping clients develop enhanced public use healthcare data products. You can read more about that here.

Rally behind “The Year of Data Quality.” During the recent Medicaid Enterprise Systems Conference (MESC) in Portland, Oregon, Julie Boughn—Director of CMS’ Data and Systems Group—named 2018 “The Year of Data Quality.” NAHDO attendees, in support of this mission, highlighted that consistent nation-wide file layouts, coupled with consistent field definitions across databases, could go a long way in improving data quality in health IT solutions, such as APCDs.

In sum, the annual meeting was an excellent venue for hearing from data gurus, state health information officials, and those passionate about affecting change through health data solutions. As the conference in years past was attended mostly by APCD gurus, the stakeholder audience continues to broaden to include all those who have a hand in improving citizens’ health and well-being.

Read this if you are a state public health agency or a key interested party in state public health data systems design, development, and implementation.

In recent years, addressing disease risk through mitigation of Social Determinants of Health (SDOH) has become a shared goal between public health and the Centers for Medicare & Medicaid Services (CMS), bringing these agencies into the limelight for efforts to reduce healthcare costs, mitigate disease, and improve the health of the population. Efforts include leveraging Health Information Technology (HIT) and data sharing for electronic reporting of disease surveillance data, lab data, and health registry data. To do this, state agencies need to develop, enhance, or procure capable data systems and identify funding sources to support this work. With the number and size of data system enhancements needed and the fluctuations of public health funding, public health agencies need long-term, sustainable funding sources.

CMS policies and initiatives such as Electronic Health Record (EHR) Incentives, 21st Century Cures Act, Promoting Interoperability, and Medicaid Enterprise Systems (MES) are consistently, and sustainably funded through federal allocations to support HIT design, development, and implementation. When state Medicaid programs and public health agencies are able to identify shared goals and electronic reporting needs, joint efforts can tap into the same federal funding sources used by CMS to support the design, development, and implementation of public health data systems. State public health agencies who want or need to leverage this opportunity for federal funding will need to build or strengthen partnerships with their state Medicaid offices to learn more about applying for funding by submitting an updated Advance Planning Document (APD).

What is the Medicaid Enterprise System (MES)?

The MES is a modernized, state-based Medicaid Management Information System (MMIS) that uses modules to support enterprise-level systems interoperability. The MES is designed to help states efficiently manage and deliver Medicaid-funded services to their eligible populations and streamline interoperability across healthcare providers and regulatory agencies, including public health agencies. The development and adoption of the MES is part of CMS’s Promoting Interoperability Program.

The Promoting Interoperability Program and the development of the MES modules are built upon past programs for healthcare provider EHR incentives. These programs funded certified EHR system enhancements to electronically report health and billing information to state and federal agencies. As part of Promoting Interoperability, the reporting requirements have been updated to include electronic health information exchange and exchanging data with public health agencies. For calendar year 2023, CMS-certified systems are required to report on four scored objectives and their measures:

• Electronic prescribing
• Health Information Exchange (HIE)
• Provider to Patient Exchange
• Public Health and Clinical Data Exchange

The Public Health and Clinical Data Exchange objective requires that eligible hospitals and CMS-qualified providers actively engage with a public health agency or clinical data registry to submit electronic public health data. Data submission requirements for the Public Health and Clinical Data Exchange Objective may include the following:

• Immunization registry reporting
• Syndromic surveillance reporting
• Specialized registry reporting for either public health registries or clinical registries
• Electronic reportable laboratory results reporting
• Electronic case reporting
• Funding public health systems development

With the addition of the Public Health and Clinical Data Exchange objective, healthcare providers and state agencies are eligible for federal funding to support HIT systems design, development, and implementation. While several public health infrastructure and data modernization funding opportunities are available, MES federal funding can be leveraged to cover the costs of system enhancement, thus freeing up other funding sources to support modernized data management and use. As an example, MES funding can support immunization registry development while public health infrastructure funding supports data visualization tools and integration.

To apply for federal funding, state public health agencies will need to partner closely with their state Medicaid offices to understand their current and past APD processes, submissions, and approvals. Collaboration between Medicaid offices and state public health agencies is critical for this process since the APD submission and approval process is managed by CMS regional offices. The public health field is plagued by siloed programs and data systems that challenge collaboration efforts. Cross-agency collaboration between public health and Medicaid can be an additional challenge, but not one that cannot be overcome.

If you have any questions, please contact BerryDunn’s Public Health or Medicaid consulting teams for Public Health and/or Medicaid Agencies. We’re here to help!