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- All right, you know what time it is?
It's TGIF, time for In Case You Missed It,
GovTech's weekly news roundup.
Now today we're talking health equity for state government.
There's upcoming changes in quality measures
for Medicaid and CHIP, and this is gonna have an impact
on all state government agencies.
So today we're gonna be looking at those new rules, data,
and approaches specifically around the technology components
and those foundational elements that need to be
in place to support these new reporting requirements.
We'll also be looking at what the future holds
for states that have the right foundation to
implement these new rules correctly.
And Joe and I are back at it, but we've brought two experts
from Optum in to help us make sense of what's happening.
We have Mylynn Tufte, Practice Lead,
Population Health for Optum Advisory Services.
And Meta Kreiner, the Practice Lead for Population Health
for Optum Advisory Services as well.
Mylynn and Meta, thank you so much for carving some time
out to break down this really complex topic for us and
help make state governments understand what to do with it.
- Great. Thanks for having us.
- So maybe to start, I'd love to get to know a little bit
about both of you and your backgrounds and
kind of how you got to where you're at today.
And Meta, let's start with you for this one.
Tell us a little bit about yourself.
- Sure, I have a master's in Community Health
and I am the Population Health specialist
in Optum State Government Solutions.
And prior to that I worked
for the state of Michigan in their Medicaid bureau.
- Fantastic. And Mylynn, how about you?
- Sure, thank you.
Mylynn Tufte, I am a nurse, as well as I also
have a business degree in Information Systems Management.
I've been in Population Health consulting a long time.
But prior to returning to Optum,
I ran the Department of Health for the state of North Dakota
for three and a half years and live in North Dakota.
- That's awesome.
My wife's a registered nurse
so I know I'm in good company today.
Mylynn, maybe you could kick us off by helping us dig into
what is health equity and health equity measurement?
- Well, it's really good for us to ground on
what that definition is around health equity.
And we believe it's having the resources
and access to care wherever you need it
at the time that you need it.
And it's that equality, the equity around that.
When we talk about equity,
we also hear people talking about social determinants
of health and the importance of those social determinants
in their overall health and wellbeing.
- Yeah, I think that's super important
for us to kind of ground ourselves in the right definition.
But as I mentioned kind of at the beginning,
we've got some changes that are coming especially
around quality and health equity measures themselves.
And so Meta, I'd like to go to you for this.
Tell us a little bit about
how this is gonna impact state government.
- Sure. So I think one of the drivers of quality
and health equity metrics for state Medicaid programs
are what are called the CMS core sets.
And these are metrics that have been carefully selected
and provided by CMS, by the federal government,
for all state Medicaid programs.
And they're kind of divided into three lists.
One of them is the child core set,
so those are metrics for children and their health needs.
Another one for adults.
And both of those have a subset that's kind of
focused on behavioral health.
And then there's a third one
which is the Health Homes core set.
And that's for states.
And I think the last time I looked is about 19 states
that have a Health Home program within their Medicaid.
So these core sets and these metrics,
they've all been around for about 10 years now
but reporting has been voluntary.
And what's changing, and it's kind of been known as coming
for a couple of years, is that they're gonna be mandatory.
And that is set for federal fiscal year 2024.
It is going to be based on a proposed rule that came
out this summer, starting to give us a sense
of what that mandatory reporting is gonna look like.
It's gonna be the full child core set,
the behavioral health portion of the adult core set,
and the Health Homes core set
for states that have Health Homes.
So that's what's coming for federal fiscal year '24,
which might sound like it's far away,
but that means 2023 data.
So that means services and care
that's being provided right now starting this month.
So it's actually a little bit sooner than it might seem.
- And I bet-
Go ahead, sorry.
- Go ahead.
- I was gonna say that it does seem soon,
especially for a bunch of new administrations
that have taken office as well at the state level.
- Right, yeah, with quality metrics
you're always kind of going back in time a little bit.
So you really have to be prepared.
And this proposed rule kind of helps to sort of
see what's coming in terms of the mandatory requirements.
And you know, one of 'em is clearly,
it's a focus on national consistency in reporting.
While it's been voluntary, states have had a little leeway
to use some different methodologies,
maybe include different portions
of their Medicaid populations, right?
'Cause Medicaid's really a lot of different programs
that can look a little different.
And so that consistency,
that's gonna be a new element, I think.
And the other piece is that it's not just
for the national focus, it's really also to be a resource.
And you can see that in the proposed rule
for state governments and state Medicaid programs
and give them some Medicaid focused metrics for monitoring
and quality improvement within their own programs.
Which is gonna mean partnering with providers
and managed care organizations to do that work.
And the last piece I think comes back around
to what Mylynn was saying, which is there's really,
health equity is really at the forefront of this too.
So it's not just looking like one rate for each state,
but there's also a real focus on stratifying those rates
so that you can see if there are any disparities
or differences for different populations.
And while it's been voluntary, that focus has been on age,
sex, race/ethnicity, geography, urban/rural,
but looks like in that proposed rule
that those stratifications are gonna get expanded.
And that whole focus on health equity
is just gonna keep growing.
- You know, you're right in terms of
A, providing a phenomenal breakdown of what's coming,
but that it's a quick, relatively quick turnaround.
So Mylynn, who's ultimately responsible
for implementing these standards at the state level?
- Yeah, you know there are so many different stakeholders
that are responsible for this collection
of data standards and quality measures.
And it's important to have one person that's
accountable to do this, but it really takes leadership
from the top to understand the importance of these measures
and the input from all those stakeholders
that Meta talked about.
Our provider community, our payer community,
our community benefit organizations that really feed
into those measures.
So while it may be, if it was Meta in Michigan at the time,
it may be Meta, but there are such a team of people
that really bring this together
in order for states to be successful in reporting.
- Absolutely. So, you know, as we take a couple steps back,
I'd love to maybe frame for our audience,
what are some of those common challenges that
state government agencies are dealing with surrounding
health equity and reporting requirements today
in the context of everything else that they've got?
Meta, I'd love to hear from you on this one.
- Sure, yeah.
So one of those challenges is really specific
to these core sets is that these metrics are complex.
This is not just counts of services.
And I think the last report I saw is about,
the average state is reporting about two thirds
of the metrics right now while they're voluntary.
And part of that is the challenge
of getting the data together for this.
Some of the metrics are administrative.
So they're a little bit more straightforward
in terms of, you know, you're pulling together
your Medicaid eligibility claims and encounters.
If your physical health and your behavioral health,
they're in two different systems, bringing those together.
Pharmacy.
But there's more and more of a focus on health outcomes,
metrics, that go to that next level.
And that means, really, data integration.
And one of the resources or one of the benefits
for state governments is that
Medicaid is just one piece of it, right?
And there's also public health,
and public health has other data sets that can really be
a great asset for these kinds of metrics.
Like vital records, childhood immunization registries,
but that means data integration because just
because they're all in state government doesn't mean
that they aren't housed in different places.
Then you've gotta get to data sharing agreements
and actually bringing this data together,
person matching and all of those challenges.
So data security, lots of complex pieces,
but really rewarding when you're able to link together
the services and the health outcomes.
I think another challenge with that is even with that
resource of your public health, health outcomes data,
a lot of these metrics are still looking for clinical data.
And that can be really challenging
for public health, for Medicaid programs.
It used to mean medical record review,
actually pulling down paper files.
Now that means the technology to integrate with
electronic health records, health information exchange.
So that can be another challenge.
And I think these stratifications
also often mean another data set.
Medicaid can sometimes have incomplete demographics
when you're talking about data integration.
The different systems could collect and store
this data in different ways.
And so you've got all of that, those data elements as well.
- So a lot of data that has to be kind of
wrangled right now as a part of that.
So yeah, I love that breakdown.
And Mylynn, I'd love to kind of shift to you,
because you were in this seat before.
So as you kind of think about wrestling that data
that Meta was talking about,
what are the technology components that really need to be
in place to support that and all the new requirements
that are coming and anything else states should be doing to
kind of operationalize the data?
- Yeah, thanks Dustin.
Even before we talk about technology and technology systems,
I always try to remind people, let's step back and look
at our overall strategy and what we're trying to achieve.
And having that good strategy that you can communicate
to those stakeholders is so important.
When you have the strategy, then you can do the assessment
around your technology and technology components
and understand where the gaps might be.
Meta talked a lot about data interoperability.
Data governance is so important so that individuals
that we're serving have trust in giving us,
providing us with the data.
And then us to be able to share that within the
regulatory constraints or environment that we live in.
Those are all considerations for us to be good stewards
and be able to deliver on what we have to do
and want to do to improve health equity
and health outcomes in the state.
The other thing that I would say is,
states that do this right are really making heavy
investments in analytics and looking for technologies
that can advance the work that they do
through automation and use of AI or machine learning.
But I'd step back and really say that that,
a level of technology and analytics that's required to
do identification and stratification is so important.
So that the resources that you do have
within the state are going to the best and highest use.
- You know, I wanna kind of piggyback on that a little bit.
I'm thinking in terms of the audience
that's tuning in today, right?
What actions should they be taking
if they're a technologist, if they're a program manager,
if they're coming from that data angle that
that you just kind of uncovered?
Meta, maybe you could share with us,
whether it's the people, the process, the technology,
what should states be considering now to handle that,
their data, their health equity measurement?
- Yeah, I think that you can think
about these reports as this once a year, one time thing,
but it really builds on everything you're doing every day
across all the different positions
that you were just listing there.
You know, it's really about your day-to-day operations
and the technologies you have in terms of collecting
this data, storing it, and then your analytics teams,
but also the people providing the services, right?
The providers, the hospitals, clinics,
your managed care plan organizations
if it's a managed care plan state, managed care state.
Because they're the ones who are gonna be playing a role
with the data collection.
And then it's really important, I think,
as sort of Mylynn was saying, to share those results,
get everyone sort of on the same page about the
importance of that, seeing those disparities.
Because they're also gonna be your partners
when you're doing quality improvement
and working to address those disparities and improve care.
And then those are multi-year initiatives
and brings you right back to data collection again.
So I think the key here is that really good metrics and
good health equity analytics build on
everything you do every day for strong operations.
- That's such a good point.
So now let's kinda shift
and talk a little bit about the future.
And Mylynn, I'd love to get your take on this
as we kind of look to the future.
You know, what is the future
for states that have the right foundation,
that implement these new procedures
and kind of the foundational elements correctly?
What does the future look like for them?
- Well, the future that I'm dreaming about is really a
future where we don't have these disparities in healthcare,
and that people do achieve that optimal health,
and they have those resources at their fingertips.
So that's the future that I'm dreaming about.
The states that are doing it well,
truthfully they've been funded and they have the people,
the process and technology,
and they've been able to bring it together.
But I want to make sure that everyone's working towards this
and there's that awareness that everyone has a part to play
in driving good health equity
and health outcomes for their state constituents.
Whether you're sitting in technology,
whether you are the nurse in the public health department
or you're running a Medicaid department,
that's the future.
When we all work together inside government
and outside government with our key stakeholders,
that's when we're gonna really make a difference.
- I love that.
I think that that aligns to the mission that we have
as an organization in terms of making government better,
and I think that the health equity measurement
in improving healthcare outcomes is a massive part of that.
So, Mylynn, I wanna stay with you for a second.
This is probably the easiest question that
you've got all afternoon here,
but where can our audience go to learn more
about Optum State Government Solutions,
and how you're working with states
to prepare them for these new requirements?
- Yeah, we'd love to talk to you.
We'd love to hear from you.
You could reach out to me, you could reach out to Meta,
you can see our email contacts that are running
across the screen.
In addition, you can find out more information,
things that we've published around thought leadership,
other capabilities and resources that we have
at optum.com/stategov.
That's another great resource to access some
of the things that we've been talking about today,
as well as other things that you might need at your state.
- Awesome. Well, Meta, Mylynn, thank you so much
for taking time out of your day to join us
and to share a little bit of insight
into these new requirements and what they mean to states.
So thank you both.
- Thank you.
- Yeah.
- Have a wonderful-
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