How Medicaid Offices Identify New Innovations
Our Interview with a State HIT Coordinator
The Nexus | June 2019 | Edition 02
We recently interviewed Lorie Mayer, the Health Information Technology Coordinator at the Arizona Health Care Cost Containment System (AHCCCS). Our goal was to better understand how state Medicaid offices identify new delivery solutions. We asked Lorie about the process she takes when sourcing new innovations for Arizona Medicaid.
Question 1: There must be a huge amount of burning needs in addressing new innovation - how do you narrow in on which priorities to focus in on and when?
Lorie's Response: The agency's Executive Leadership team identifies our strategic priorities which get incorporated into our Agency's Strategic plan. This document serves as a living document for all of the staff to use and through periodic review of the plan and its metrics, we can track our progress and challenges in meeting our strategic goals.
Question 2: Once you understand a priority, how do you identify a new solution?
Lorie's Response: One of the most important methods the agency has used to identify opportunities has been through listening and engaging with our contracted Medicaid plans and participation in community events and presentations. We have frequent and structured meeting times with each Medicaid plan and one of the reoccurring agenda items is focusing on identification of emerging issues or barriers. We then can do additional research with other state Medicaid agencies, plans or stakeholders to help put any issue into a state, regional or national context. We get a lot of value by looking at what other state Medicaid offices are doing. Through our engagement with our plans and community stakeholders we will often times hear about approaches and tools that are being deployed or adopted to meet a need. We then ensure that those solutions and tools get shared among our contractors and with our community partners.
As a Follow up... If a vendor wanted to build a relationship in the state, is it ideal to do so through both the plan and through the state Medicaid office to build engagement?
Lorie: We would encourage vendors build their relationships with the organizations who can best provide testimonials to their work, in other words, good products and experiences for providers get shared with other providers, which can get shared with health plans and then with Medicaid offices. Having a quality track record with local providers and good positive local experiences are assets for any vendor to be able to show.
Question 3: Do you source exclusively through solicitations or do you also source innovation in different ways?
Lorie: The State Medicaid agency is required to follow all of our state and federal procurement codes, which we do, but we find that sometimes if we act in the role of stakeholder convener and bring disparate organizations together, they are better positioned to pursue solutions on their own, outside of the State Medicaid organization being a purchaser of a tool or solution due to their experiences as a provider or a Medicaid health plan.
Question 4: What are examples of evidence based outcomes you look for when evaluating a company? How do you de-risk a new venture, and what is the due diligence process?
Lorie: AHCCCS has a process we can go through called a Request for Information which allows us to get a sense of what solutions are already in a marketplace. This RFI process allows us to see in person demos, ask questions of vendors, ask for other state Medicaid agency examples or engagements with Medicaid populations, which helps inform our decisions about if we want to go forward with a more formal Request for Proposal which then allows us to evaluate competitive bids for a project. Our experience has been that the longer lead time we have to review and develop our requirements for a competitive bid, the better the outcome for the agency is.
Building on this... What is the lead time? What is the cycle so that vendors understand what to expect?
Lorie: The exact time frames for different projects and procurements vary depending on the complexity and type of services that are needed. Generally it takes a minimum of 6 months to put an RFP together, put it out to bid, respond to questions, review submitted proposals, and select vendors. In the event of a more complex project this same process can take up to 36 months or longer.
Question 5: For entrepreneurs who do not have experience yet working with State Medicaid offices, what advice can you give about entering and navigating the system? (especially considering managed care contract cycles)
Lorie: The first thing I think entrepreneurs should be aware of is that state Medicaid agencies have long planning cycles. They should become familiar with the state landscape and contracts which are often times on the agency websites.
The agency has a history of doing large procurement both in terms of the size of the contracts that are awarded and in the significance to how health care is expected to be delivered and paid for in Arizona. The adoption of health information technology and the deployment and use by providers of electronic clinical data sharing has changed some of the roles the state Medicaid agency has played in the past and must consider going into the future.