Because everyone matters. IBM Health and Social Programs Summit, October, 2014 Read the Health and Social Programs presentations by: John Supra, Deputy Director of Operations and Information Management and CIO Department of Health and Human Services, South Carolina Jessica Kahn Acting Director Data and Systems Group Center for Medicaid and CHIP

1. Beyond Enrollment to
Improving Quality of Care
1
John Supra
Deputy Director
Operations and
Information Management
and CIO
Department of Health and
Human Services, South
Carolina

2. Eligibility & Enrollment
Just a First Step
John Supra, Deputy Director & CIO
SC Department of Health & Human Services
IBM Health and Social Programs Summit
October 21, 2014 – Washington, DC

3. SC Eligibility
Modernizing Eligibility Systems
• Moving from 100% Paper to Online
• Enabled Statewide Staff to Process Eligibility
• Since October 2013
> Nearly 320,000 visits for 189,000 unique visitors
> Over 92,000 citizen accounts created
> Over 51,000 of 294,000 applications online (17%)
> Processed nearly 40,000 applications from FFM
• Next Steps
> Non-MAGI populations
> Renewal processes

4. SC Eligibility
Online is Great But…
Aren’t we just catching up
to the rest of the economy and
consumer expectations from
10 years ago?

5. “The real voyage of discovery consists
of not in seeking new landscapes,
but in having new eyes.”
Marcel Proust

6. Eligibility – Applications, Renewals & Decisions
Just a First Step – In Process

7. Eligibility Plan Enrollment
Just a First Step – In Process

8. Everything Else – That is Possible
Eligibility
Plan Enrollment
Provider Choices
Scheduling
Just a First Step – In Process

9. Health & Human Services Serving
One-Third Population in United States
LIHEAP
4.9M
Medicaid
68M
Unemployment
8.4 M
Housing
Assistance
SNAP
44.7 M Development
Disability
32.5M
Head Start
1 M
WIC
9.2M
TANF
4.4M
Foster
Care 500K
4.9M
Child Support
40 M
Just a First Step – In Population
Sources: Data – CMS, ACF, FNS, Census bureau websites; Concept – Stewards of Change

10. Not Enough
But We are Still Behind…
• Lack Unified Data on Citizen Interactions
> Across health and human services programs
> With other state and federal agencies
> Core “CRM” – treating citizens like your best customers
• Lack Unified Case/Clinical Data
> Eligibility, enrollment, case plans and services
> Across programs, payors and providers
• Inappropriate Data Reliance
> On administrative and claims data

11. Think Different
Bigger and Brighter Vision
• One Driven by Social Determinants
• One Focused on Outcomes
> Population Health – individual, family, community
> “Value” Driven – Aligned with Triple Aim
> Cost – Reduce per capita cost of health care
> Effectiveness – Improve the health of populations
> Experience – Improve the patient experience
• One Grounded in Local Communities
• One Enabled by Technology

12. “The average person today
processes more data in a single
day than a person in the 1500’s
did in an entire lifetime.”
The Human Face of Big Data
Rick Smolan & Jennifer Erwitt

13. Streams
“Don’t Cross the Streams”
Scene from Ghostbusters, copyright Columbia Pictures

14. Streams
What are Our Streams?
•Silo’d Policy Streams
•Isolated Funding Streams
•Duplicative Streams for Citizen Interactions
•Duplicative/Conflicting Delivery Streams
•Stream Challenges at State & Federal Levels

15. “One of the most common
tendencies of human nature is
that of placing responsibility on
some external agency for sins
we have committed or
mistakes we have made.”
Attributed to Dr. Martin Luther King

16. Technology
Technology as an Accelerator
• Citizen and Worker Driven Processes
> Enabling self-service, automated services
> Complete re-thinking of processes and process-design
> Planning for a mobile future
• Data-driven and Predictive Analytics
> Enables “siloed” data to be used across the enterprise (and beyond)
> Toward automated and dynamic analytics, away from reporting
> Toward payment reform (what we pay, episodes of care, risk sharing)
• South Carolina Efforts
> Toward a “purchaser of health” not a “payor of services”
> Healthy Outcomes Program (HOP) – high need uninsured
> Pay-for-Success for maternal and early childhood home visiting

17. Today
What Can We Do Today
• Using A-87 Cost Allocation
> More flexible than most believe…
• Thinking about the Enterprise & Interop
> CMS support for enterprise planning
> Need to provide, support and consume “services”
> Interoperability frameworks
> CMS/MITA, ONC (heathit.gov), Human Services (APHSA & stewardsofchange.org)
• Efforts on Data Sharing Agreements
> Templates and best practices (NASHP)
• Federal Leadership
> HHS IDEA Lab (www.hhs.gov/idealab)
> CMS Innovation Center (innovation.cms.gov)

18. Opportunities
Thinking about Tomorrow – People
• Capacity
> Intellectual curiosity, expertise and skills
> Systems, tools and access/use of data sets
• Vision and Direction
> Understanding of what is/may be possible
> Leadership prioritization
• Culture and Mindset
> Around data-driven decision making
> Around risk-taking
> Around making novel connections

19. Opportunities
Thinking about Tomorrow – IT
• Capacity
> Flexible, dynamic, on-demand computing (cloud)
> Liberated data
• Vision and Direction
> Framework and platform thinking
> “Service” infrastructure
• Culture and Mindset
> Fast delivery and willingness to iterate
> Enabler vs. inhibitor
> Managing “hybrid” or “bi-modal” development

20. “As we find new ways to use
computers, they won’t just get
better at the kinds of things
people already do; they’ll help
us to do what was previously
unimaginable.”
Zero to One
Peter Thiel

21. Questions &
Discussion

22. Beyond Enrollment to
Improving Quality of Care
22
Jessica Kahn
Acting Director
Data and Systems
Group Center for
Medicaid and CHIP

23. Medicaid- Beyond Eligibility and
Enrollment
Jess Kahn, MPH
Director, Data and Systems Group,
Center for Medicaid and CHIP Services,
Centers for Medicare & Medicaid Services
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24. Overview
• Reminder: what’s the vision
• Step 1: eligibility
• Step 2a: enrollment
• Step 2b: access to high quality care
• Step 3a: care coordination and payment
models
• Step 3b: coverage + health care services + ?? =
better health and well-being
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25. The Vision
• Better individual health (and well-being)
• Improved population health
• Lower costs
• Health insurance coverage isn’t enough on its
own
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26. Eligibility
• Still to come- bells & whistles
– All states with pre-populated online renewal
forms
– “Change in circumstances” and “benefit
management” mobile apps
– Application mobile apps
– More real-time eligibility determinations
• Expanded automated verification sources
– More integrated systems with human services
• E.g. multi-benefit applications
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27. Enrollment
• Still to come:
– Faster transactions for enrollment
– Can a SBM do automated enrollment for MCOs
too? Plan compare for MCOs?
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28. Access to Care
• Requires good data availability and analysis to
map provider resources and utilization
• What about continuity of care when there is a
transition in coverage (between Medicaid and
QHP or vice versa)?
– Overlap of provider networks between MCOs and
QHPs?
– Transition (with consent) of beneficiary data
between plans to avoid disruption in care
management
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29. Care Coordination/Payment Model
Reform
• Increased enrollment = increased demand
– Efficient use of resources
– Right incentives for better care/ outcomes- based
– Luring “new” Medicaid providers
• How easy is it for a provider to enroll in Medicaid?
• What about the role of HIT/E?
– How HIT-enabled are providers serving the newly
covered? In general?
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30. What else drives health?
• Integration with human services
– Better consumer experience (operationally)
– Lower IT investments
– But… what about the consumer’s overall health
outcomes?
• Integrated case management
• Predictive modeling
• What else should be considered for integration
with Medicaid/CHIP data to meet the triple aim?
– Juvenile Justice?
– School health?
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31. How?
• Smart technology
– Software as a Service and COTS
– Enterprise Service Bus
– Enterprise Data Management/Warehouse/BI Tools
– Enterprise Identity Management
• Smart IT architecture
– Enterprise Data Models
– Modularity
– Don’t fear the Cloud
• Smart IT Procurement
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32. Questions?
• Contact information:
– Jessica.kahn@cms.hhs.gov
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