CMS BLOG
January 11, 2016
By Andy Slavitt, Acting
Administrator (@aslavitt)
Encouraging
Investment in Medicaid Information Technology
Over the last two plus years, more
than 13.5 million new people gained the security of Medicaid or CHIP coverage,
solidifying its role as the foundation of the nation's health system providing
insurance to almost 72 million people nationally.
At the same time that we at CMS are
focused on helping interested states expand coverage, we are equally focused on
rapidly transforming and modernizing Medicaid coverage, focusing on the
enrollment experience, access to care and the quality of care with the goal that
Medicaid coverage works as well or better than any insurance program. And there
is great opportunity to do this in a manner that respects and capitalizes on
the ability of each state to innovate in a way that's appropriate to the needs
of its local population, but also one that aligns with national goals for
improving the delivery system.
This last year, we proposed rules to modernize how Medicaid managed care
works, how states and CMS ensure access to care, and are working state by state
on their plans to improve incentives to the delivery system for delivering care
that results in better care, smarter spending and healthier people. And thanks
to the Affordable Care Act, we now have a fully automated eligibility and
enrollment process for Medicaid consumers.
Serving the Medicaid consumer
better takes meaningful investment in infrastructure to help serve low-income
individuals, many with less regular interactions with the health care system,
coordinate care, organize long-term services and support, and ensure quality
measurement and delivery system reform plans can be executed. Investing in the
future of Medicaid is one of the single biggest opportunities in the health
care sector.
That's why last month CMS
permanently extended the 90 percent federal match for investments Medicaid
systems. Overall, CMS’ annual investment in state Medicaid Information
Technology (IT) is more than $5 billion, enabling states to modernize their
Medicaid IT systems to best meet their program, providers’ and beneficiaries’
needs. CMS and states are prepared to invest in innovative solutions.
For this investment, we expect
significant advances. Our new regulations require that states evolve their
legacy Medicaid IT systems to leverage reusable solutions, and to practice
industry-proven IT methods such as use of modularity, reuse, shared services
(including Software-as-a-Service) by fundamentally shifting the financial
incentives away from custom development. This opens opportunity to smaller
vendors to develop focused solutions for use across multiple states or to
introduce solutions from comparable sectors such as commercial insurance or
large provider systems. We believe this approach will expedite states’ IT
timelines, decrease overall costs, and ignite adoption of advanced technology
solutions
To help the technology community,
and in particular new entrants, enter this solution space, we are not only
providing the funds, we've also created a one-stop-shop set of resources to
begin the work. To help the tech community connect with states looking for
innovative solutions, today we are launching a new Medicaid program resource (https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/procurement-opportunities.html)
that will help private sector companies identify opportunities to participate
in this important market. On this site, vendors can easily find links to
states’ Medicaid procurement websites and to any open state Medicaid IT
Requests for Proposals.
Building upon the final regulation
and new state procurement webpage, CMS will also be issuing a series of state
guidance documents, initiating a new certification process for Medicaid system
modules, and issuing a Request for Information (RFI) that will ask the broader
IT vendor community how we can best position our investments coupled with
states’ technology needs and break out of the same old solutions. We
welcome input from industry, states, consumers, and the private sector on our
vision to transform Medicaid IT.
Why should small, innovative
companies and their investors be attracted to the state Medicaid IT space? As a
former entrepreneur myself, I give you three reasons:
- The opportunity is big: Medicaid and the
Children’s Health Insurance Program (CHIP) provide health coverage to
nearly 72 million Americans, and are consistently growing as more states
choose to expand coverage. With over 30 states currently
redesigning their Medicaid eligibility and/or claims processing and
information retrieval systems, 2016 will the most active year to date for
Medicaid growth and new IT business prospects. CMS and states want to
make the most of this opportunity.
-
- The problem-solving
opportunity is exciting: The Medicaid program is undergoing tremendous change,
such as a growing emphasis on managed care, offering home and
community-based services to seniors and people with disabilities, and developing
new models of delivery system reform to improve health outcomes while
controlling costs. State Medicaid agencies are hungry for innovation and
have pioneered new IT adoption. They were early adopters of Health
Information Technology and have issued more than $10.2 billion in
incentive payments to providers for adopted and meaningfully used
electronic health records.
-
- There's no better
mission:
There's no better mission than helping families get the care they need,
piloting new approaches that will serve as models for care delivery in the
U.S., and building a lasting business around it.
And we are making it easy -- with
access to funding and resources -- to encourage our best and brightest to
be a part of this important change occurring right now. The improvements that
come from this will not only provide consumers with a better experience, they
will improve the fairness of our system, the efficiency of how care delivery
works and the health of our nation.
No comments:
Post a Comment