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The 2019 State Healthcare IT (HIT) Connect Summit kicked of its 3-day event in Baltimore’s Inner Harbor on Monday, March 18, 2019, welcoming hundreds of federal and state government healthcare professionals to join the discussion surrounding implementation strategies for health IT systems. Bringing together thought leaders from both the policy and technology side of government healthcare enterprise systems as well as some of the most innovative IT vendors in the world created an exciting dialogue around the biggest challenges facing these programs and the systems supporting them – and, more importantly, the innovations and forward-thinking approaches being used today to solve them.

It always comes back to modularity

Modularity is “not a thing of the past.” Julie Boughn, Director, Data and Systems Group, U.S. Centers for Medicare and Medicaid Services (CMS), kicked off the 2019 State Healthcare IT Connect Summit Day 2 keynote with a clear message – modularity is not going away as a priority. What is changing is the way the government healthcare community is looking at it. Emphasizing how CMS continues to work with states on “delivering outcomes, not projects,” Julie highlighted initiatives designed to empower states with timely, accurate, and complete data.

This emphasis on data quality mirrors what Pega continues to see among states initiating their modular implementations. States are developing their Medicaid Enterprise System modernization strategies with a focus on ensuring process and data standardization. While the approach to standardization varies across states, they are no longer just checking the box for program administrative functions. States are laser-focused on access to data for driving better program outcomes. We spoke with states who designed and are executing plans that drive standards via technical platforms, system integrators, and formal governance programs.

Driving modularity and interoperability with a platform-based approach to MMIS

Pega and Conduent hosted a joint roundtable discussion with 20+ federal and state agencies to discuss the challenges and approaches for executing a modular strategy for Medicaid Enterprise Systems. Technology Solutions Leader Vinay Koneru from Conduent opened the session, sharing his experience in implementing complex healthcare solutions in both the commercial and government space. Vinay sees three paths being taken today toward modularity:

  • building a large enterprise system using a single technology set, defining standards and processes as you go along,
  • procuring individual module functionality based on differing technology sets and standards, and
  • establishing a set of data and process standards up front and procuring technology sets that meet these standards.

The discussion primarily revolved around establishing standards across modules to ensure interoperability and data quality. The challenge we heard during the session, as well as in interactions with states throughout the conference, is at what level these standards should be established. States already ensure federal requirements are met but continue to seek even deeper guidance on how to ensure interoperability standards between different technologies and vendors.

Platform-based technology viewed as the data and process standard

In our experience working with state and federal government healthcare agencies as well as commercial healthcare customers, we have found modern application development platforms – also called digital process automation platforms – are a way to create an orchestration layer that can sit below individual modules and serve as the glue that connects them. A single platform that coordinates business processes and integrations between modules creates the technology standardization that clears the path toward a successful modular implementation.

Government agencies are finding success with a platform-based approach

We have seen this platform-based approach work well for creating standardization across modules and serving as a connecting point across all. For example, the U.S. Centers for Medicare & Medicaid Servicesleverages the Pega Platform™ to connect its customer service front-end to its back-end case management system for citizen appeals resulting from healthcare.gov decisions. Similarly, the California Franchise Tax Board leverages a Pega Platform-based approach for managing business rules and workflow between multiple systems leveraged for tax return processing.

In our experience, a growing number of states see a platform-based approach as a means of standardizing the orchestration of integration, rules, and workflow across disparate system.

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