Enabling Integrated Services Delivery

As the saying goes, it takes a village to deliver different health and social programs to constituents. And yet, most of these programs remain in silos. States have been making efforts to modernize and enable Integrated Services Delivery to improve care, outcomes and lower cost. Now they have an opportunity to further their Integrated Service Delivery goals by taking advantage of the synergies in functionality and available funding to modernize their social program systems.

Since the A-87 waiver is over, enhanced funding is not possible for some projects. Systems developed under enhanced Medicaid funding generally can be implemented at a 90% match. SNAP or other programs can be added later for a smaller cost than a separate implementation.

Use of a Medicaid Enterprise System (MES) integration platform to modernize Medicaid will also make it easier to integrate disparate social programs, bringing educational, child welfare, childcare, clinical, vaccination, and other data together to enable Integrated Services Delivery with a 360 view of a person’s situation and potential needs. This will make it easier to create a comprehensive, multi-program care and benefits plan.  Something that would not be possible at all without Integrated Service Delivery.

Leveraging a unified automated data science-based analytics platform can further optimize outcomes.

  • It can help define and deliver personalized and targeted interventions
  • It can provide a comprehensive view of the current state and the ability to model potential future benefits and costs through Machine Learning (ML) and Artificial Intelligence (AI)
  • It can help agencies identify programs that will benefit most and what the potential benefit may be instead of a “try and fail and try again” approach to Integrated Service Delivery

There are five potential approaches and four solutions that can help states enable Integrated Services Delivery.

Potential Approaches

  • Unified Portal: Make it easier for customers to apply for, and manage, benefits from multiple programs (SNAP, TANF, Medicaid, etc.) through a single portal
  • Unified Case Management: Empower a single case worker to manage multiple programs, enabling limited “wrap around” based on case worker skills
  • Unified Contact Center: Build a single “pane of glass” view across programs to enable holistic interaction with callers
  • Data First: Get your data in line before you try to enable ISD. Without knowing your data, you cannot integrate your programs
  • Functionality First: It’s about helping the customer. You can integrate at the application level with minimal effort – mapping application to application with mutual identifies, such as telephone number. Get some quick wins, relieve some pain points, and give yourself time to do the comprehensive work

 

Potential Solutions

  • Data Integration with Predictive “best next”: A “holy grail” where data is semantically normalized from programs and potentially even medical encounters (clinical and claims). AI solutions can help define individualized plans with the best social and economic impacts
  • Medicaid Enterprise System: A modular approach to MMIS functionality. Components can be leveraged for other uses and programs. Data from other sources can be integrated into the Medicaid Enterprise view
  • Data Governance and Master Data Management: Implementing a solution and processes that makes it easier to share and manage data both from a policy and technology perspective
  • Robotic Process Automation (RPA): Ability to pull data from other systems without data layer integration to inform choices for caseworks and customers

States can adopt any of these approaches and solutions, in any sequence according to their requirements and priorities, to accelerate Integrated Services Delivery. If you are looking to understand what approach would work for your state, here are a few aspects you should consider:

  • What is critical today – increased worker efficiency? Comprehensive data for intelligent actionizing? Harmonizing operations? Customer benefit?  Or something else? etc.
  • What is your future state vision and how will you achieve it?
  • What skill sets exist in your current enterprise? What can be developed? What would be a challenge?
  • What history of integration and collaboration exists between agencies and departments today?
  • What regulatory environment constraints exist? How important is it to change them and how hard would that be?
  • Are you looking to optimize what generally works or fix some serious gaps?

We recommend evaluating your best fit mix of solutions and approaches based on your analysis.

We discussed this topic at the recently concluded State Healthcare IT Connect Summit. If you would like to know more or discuss how your state can work on Integrated Services Delivery, please connect with me at Rick_Brady@infosys.com.

 

 

Author Details

Richard Brady

Rick leads the Government Healthcare practice at Infosys for the US and Canada. He has 20+ years experience in healthcare and public sector.

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