by WEX Health
by Christopher Breining and Patrick Forman
As part of our ongoing effort to listen to and engage with leaders in healthcare IT, WEX Health attended the 9th Annual State Healthcare IT Connect Summit in Baltimore last week. We joined more than 700 fellow attendees, including public and private sector thought leaders, to share ideas and benchmark implementation strategies for state health IT systems as they move forward with diverse health and human services transformation programs. We were recently sharing our key takeaways from the summit with colleagues and thought WEX Health Trends & Insights readers may be interested in them, too. Here are some of the most interesting things we heard:
1. “Health data is our data”: Don Rucker, National Coordinator for Health Information Technology, delivered the opening keynote, in which he spoke about the 21st Century Cures Act and the Trump administration’s focus on interoperability. The 21st Century Cures Act, of course, has allotted more than $6 billion to federal agencies and states for research and development of healthcare and medical device innovation. Rucker stated that “health data is our data,” and asserted that information blocking can no longer be accepted. He also challenged the healthcare community from vendors to providers to work collaboratively toward developing and using “Open API’s without special effort”.
2. The necessity of a Medicaid-centered platform: A panel on “State Readiness for the Next Phase of Marketplace Reform” offered recommendations and best practices for engaging with the Department of Health and Human Services to design state-based coverage solutions. (That’s something WEX Health has been working with Project Poplin on as we bring our government and commercial experience together to define the open architecture for financial management to the Medicaid Enterprise.) The panel included comments from Jessica Kahn, former director of data and systems for the Centers for Medicare & Medicaid Services (CMS), and emphasized that, as states explore new technology initiatives or the potential to move from the federally facilitated marketplaces (FFM), the marketplaces should start with Medicaid and then connect programs for sustainability, transitions and better health engagement. The focus was on unlocking health data to empower more informed decisions as much as it was on creating a unified marketplace and Medicaid-centered platform that would enable states’ flexibility in designing affordable programs that empower members/consumers to plan for health expenses and pay premiums. Panelists also indicated that the CMS budget allocates less money for Navigators to assist in enrollment so enrollment on FFM is expected to decline; FFM enrollment during 2018 Open Enrollment declined (-10.5 percent) while SBM enrollment increased (+1.5 percent).
Finally, the discussion turned to the use of 1332 Waivers and how the administration wants to give states flexibility with enrollment and benefit design. Panelists explained how both FFM and state-based marketplace (SBM) states should look to 1332/1115 Waiver programs and design integrated/interoperable systems between Medicaid, Marketplace and Locality so that program innovations provide 360-degree connections across populations. Systems should look to maximize Medicaid funding and use data to foster greater collaboration between State, Plan, Provider and Member. Medicaid Plans and Medicaid Buy-in on the Exchange is a direction being explored by states with SBMs.
3. States are open to a modular approach to Medicaid: In a session on “Integrating the Modular Medicaid Enterprise: Definitions, Expansion and Traction in the Vendor Marketplace,” panelists discussed the challenges (from the vendor perspective) of selling into a state marketplace that’s difficult for best-of-breed point solutions to penetrate. CSG Government Solutions’ Healthcare and Human Services presented the results of a survey of vendors of how best to decompose the various business processes into a truly modular solution. Financial management, per the survey results, was seen as a loosely coupled solution set. The panel talked through the interoperability demands that a modular approach will impose, and Project Poplin was mentioned as a way to define inputs and outputs for loosely coupled modules. Ultimately, the panel reflected the state community’s openness to a modular approach to Medicaid and financial management, with the key challenges being procurement and interoperability.
Vice President of Healthcare Vertical Sales, Billing and Public Sector at WEX Health
WEX Health is an organization with a mission to simplify the business of paying for healthcare. Patrick is responsible for WEX Health growth in the State and Local government market.
Vice President of Vertical Sales, Billing and Public Sector at WEX Health
Chris Breining Vice President of Vertical Sales, Billing and Public Sector at WEX Health, a leading payments technology company in the healthcare industry. Chris is an experienced executive with a demonstrated history of consulting and sales in the Global Public Sector focused primarily on Health, Social and Human Services as well as the financial services industry developed during his career at Oracle, Cúram Software, and IBM Watson Health.
Chris led sales of many Integrated Eligibility and State-based Exchanges during the implementation of the Affordable Care Act. Chris was global sales leader for IBM Watson Health Care Manager leveraging his 20+ years of progressive experience in the government healthcare space. Chris brings expertise in government relations, Medicaid/Medicare/Exchange policy, MCO and ACO models, MITA, value-based purchasing, population health management, whole person-centered care, social determinants, care management and consumer engagement with the underserved and vulnerable populations to WEX Health.