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Healthcare Reform

That Other Fall Kickoff: Medicaid Leaders Gather in Charleston, S.C.

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“There are real people behind our spreadsheets.”

The 2013 Medicaid Enterprise Systems Conference (MESC) launched in earnest today, in an annual gathering of more than 1,000 thought leaders in government and the private sector sharing ideas related to Medicaid systems and initiatives. As this pivotal year in healthcare reform accelerates into its home stretch, representatives from all 50 states descended on Charleston, S.C., and HealthBiz Decoded was there to report.

Over a star-studded opening day, we teased out the major themes likely to have people talking in the coming days.

Enabling innovation

“Don’t you realize there are a lot of things due in a couple of weeks?” asked Michael Collisi of South Carolina, the self-proclaimed “emcee” of proceedings, expressing surprise at such a massive turnout with the insurance exchanges opening for business in just 22 days. The imminent deadlines and go-live dates, October 1, January 1, October 1 (2014) — and more — seemed to be on everyone’s minds all day.

“What are y’all doin here?” joked Anthony E. “Tony” Keck, director of the South Carolina Department of Health and Human Services. “Maybe we’re not as far behind as we think we are.”

 “Let’s figure out what the 2010, 2020, 2050 problem is, and design solutions for that.”

The official theme of MESC 2013 is “enabling innovation,” which is only possible by first understanding the nature of the state you’re in, he told a room full of state representatives.

“South Carolina is as different from Vermont or Iowa as Britain is from France or the  U.S.,” he said. Each state has a different history and requires customized solutions.

“We don’t want to be fighting the wars of the past,” he said. “Let’s figure out what the 2010, 2020, 2050 problem is, and design solutions for that.”

The importance of Data

“We need systems that help us peer into our data and make much better decisions much quicker,” Collisi said, introducing another emerging theme. He called the huge amount of data generated by Medicaid, which still can’t be quickly analyzed and used to make care decisions, “a tragedy.”

Deputy Director of the Center for Medicaid and CHIP Services Julie Boughn echoed that sentiment in “Medicaid Moving Forward: an IT Perspective.

“Who wishes we had more time?” she asked, referring again to all the deadlines bearing down on the healthcare industry. “If you didn’t raise your hand I think you’re lying.”

But Boughn was upbeat about the future, and reassured everyone that all the states using the federal exchange are going to be ready on October 1. The federal call center went live in July, she said, and she and her team are furiously lining up metrics and data sharing channels to measure the success of implementation on October 1, 2 and beyond.

“Years from now I hope we will look back and say: ‘We worked together and we made history.’”

She looks forward to weekly updates from every state on a short list of key performance indicators, like total call volume, call wait times, accounts transferred, number of enrollments and renewals and pending applications, and more. That kind of data will provide operational insight and response, she said. Her positivity was infectious.

“We want to measure, understand, change behavior and improve quality,” she said. “Those four things are not happening without data and information.”

Data at a national level seems attractive, but true real-time predictive analytics will happen at the state level, she said.

“We’re going to do this, by hook or by crook,” she said. “Years from now I hope we will look back and say: ‘We worked together and we made history.’”

Telling real stories

While that positive attitude was buoyed by surprisingly large attendance even during healthcare’s most hectic time, there was a sobering message as well: healthcare is a personal experience for everyone, it’s more than a business.

Collisi told the story of meeting a family in South Carolina with a disabled teenage daughter who brings joy to her family, but wouldn’t be a part of their lives if not for Medicaid services.

“Medicaid helps people live as healthy and as normal lives as possible,” he said.

David Goldhill, author of “Catastrophic Care: How American Healthcare Killed My Father- And How We Can Fix It” told stories of his personal experiences of healthcare in his keynote address.

“My interest in healthcare started six years ago when my father walked into a hospital from work with some shortness of breath,  and 48 hours later was dying of a hospital acquired infection,” which kill more than 100,000 Americans yearly, he said.

He argued that 75 percent of those deaths could be prevented with little to no cost, as Peter Provonost pointed out in a 2010 editorial in the New Yorker, but changes in the hospital system almost never happen because the incentives aren’t there.

“Medicaid helps people live as healthy and as normal lives as possible”

Healthcare is “broken” because we think of it as different from every other industry, he said. He argued change and innovation needs to be incentivized before it can happen – leaders need to be thinking every day about how to make healthcare cheap and simple, which is just beginning to happen cross the country, he said.

Bridging divides

Compromise might be the unspoken theme of the conference, since the host state itself openly opposes the Affordable Care Act and is not expanding Medicaid, but warmly welcomed representatives from every side of the aisle.

In fact, republican South Carolina governor Nikki R. Haley attended in person (though many doubted she would actually show up). Every year, wherever MESC convenes, the state governor is invited to speak, but attendees who had been to every conference for the past ten years said this was the first time the governor had taken up the offer.

“When we look at the growth of healthcare costs, it’s crystal clear that it is unsustainable,” Haley said. “We need to fundamentally change the system, think about health, education, jobs, and work together to build a better state using data analytics.”