Fit and Trim
Fit and Trim States Turn to Technology For Fresh Approach to Public Health Care By Ed McKenna Faced with swelling Medicaid programs, many states are relying on innovative contracting methods and new information technologies to cut costs and boost efficien
Fit and Trim
States Turn to Technology By Ed McKenna |
Terri Brown State Medicaid Management System Contracts |
To boost enrollment in managed care plans, Maximus uses its own proprietary database program, Maxstar, to perform high-volume enrollment, client notification and other functions. In addition to Texas, the company has similar contracts with California, Colorado, Georgia, Massachusetts, Michigan and New Jersey.
In a request for proposals issued in May, Georgia proposed perhaps the most radical contracting approach yet. The state has broken its fiscal agent contract into 13 separate pieces, including systems integration, payment processing, health services administration, quality management and a decision support system.
The contract will be awarded to a single prime contractor that will manage at least six subcontractors. The subcontractors will provide best of breed services in one or more areas.
In developing their new model, Georgia officials sought to bring new players and technologies into the market and shift the focus of the health care program from processing and paying claims to outcome analysis, says Bari Kerr, director of Medicaid management information systems procurement for Georgia's Department of Medical Assistance.
The state wants to be able to keep track of "what is happening to these people when they get the services that we're paying for," she says. "The current systems don't lend themselves to doing that."
In some ways, the new arrangement will just impose order on the state's current regime, Kerr says.
"We now have the traditional fiscal agent with EDS, and then we have multiple other contracts that we have executed along the way that support the Georgia Medicaid program," Kerr says. "It has become fragmented rather than comprehensive, so this [request for proposals] was an opportunity for us to make those components more comprehensive."
The new contract will replace Georgia's fiscal agent contract, valued at about $25 million a year, as well as other niche contracts, which cost an additional $9 million a year. The new contract will run 10.5 years, including an 18-month implementation period. Proposals are due by Sept. 30, with a contract award slated for Dec. 17. The system is scheduled to become operational July 1, 2000.
But not all the states have decided to abandon the fiscal agent model.
"We've thought about it, but candidly we've made no moves to do that," says Frank DeBernardo, chief of the California Department of Health Services' Medicaid management information system and decision support system project. EDS is California's medical fiscal agent, and Delta Dental is the state's dental agent.
"There are so many trade-offs when you go to multiple contractors," DeBernardo says.
California is reaching beyond its fiscal agents to upgrade its information systems, however. It has, for example, signed the Medstat Group to a $34 million contract to join a growing number of states that are implementing data warehouses and decision support systems for their Medicaid programs. A decision support system essentially overlays the data warehouse to provide easy access to data.
According to HCFA, 17 states reported in summer 1996 that they had a data warehouse and decision support system in place or were in the process of implementing one.
These data systems make up for the data access shortcomings of Medicaid management information systems.
"The flaw in the MMIS is it is easy to get data into it, but difficult to get it out, particularly if it requires special programming," says Consultec's McKay.
The data warehouse and decision support system Medstat is installing in California is about 40 percent finished, says DeBernardo.
To build the new system, "we took a feed from the existing transaction or claims payment system, and then built a separate database," says Medstat's Solomon.
Medstat is implementing data warehouse and decision support systems in eight states. The company also provides what it calls managed care information services for state Medicaid agencies helping them develop their information infrastructures, he adds.
IBM served as a subcontractor to Medstat on the California project, which is using an OS 390 DB2 platform. For IBM, this represents part of a strategy to build a presence in the Medicaid market.
Acknowledging a lack of experience in the market, Carlson says the company is "taking a fairly measured approach to getting into this marketplace."
"We're really looking at how we can be successful, add value and build the credentials required to be a sustained vendor in this marketplace," he says.
State | Fiscal Agent | Contract Start | Contract End With Extensions | Alabama | EDS | 10/1/93 | 9/30/99 |
Alaska | First Health Services Corp. | 1/1/88 | 12/31/99 |
Arizona | State-operated | NA | NA |
Arkansas | EDS | 1/1/97 | 12/30/02 |
California | EDS 1 | 6/1/93 | 6/30/00 |
Colorado | Blue Cross/Blue Shield 2 | 7/1/89 | 9/30/98 |
Connecticut | EDS | 11/1/93 | 12/31/03 |
Delaware | EDS | 7/1/90 | 6/30/00 |
Florida | Unisys 2 | 7/1/94 | 6/30/99 |
Georgia | EDS | 7/1/92 | 6/30/00 |
Hawaii | Blue Cross/Blue Shield | 12/28/90 | 6/30/99 |
Idaho | EDS | 6/1/95 | 12/31/03 |
Illinois | State-operated | NA | NA |
Indiana | EDS 3 | 1/1/99 | 12/31/04 |
Iowa | Consultec Inc. | 7/1/97 | 6/30/05 |
Kansas | Blue Cross/Blue Shield | 11/1/96 | 6/30/07 |
Kentucky | Unisys | 1/9/95 | 11/30/00 |
Louisiana | Unisys | 1/1/98 | 12/31/03 |
Maine | State-operated | NA | NA |
Maryland | State-operated | NA | NA |
Massachusetts | State-operated 4 | NA | NA |
Michigan | State-operated | NA | NA |
Minnesota | State-operated | NA | NA |
Mississippi | EDS | 5/2/94 | 12/30/00 |
Missouri | GTE Data Services | 7/1/93 | 6/30/00 |
Montana | Consultec Inc. | 7/1/96 | 6/30/06 |
Nebraska | State-operated | NA | NA |
Nevada | Blue Cross/Blue Shield 5 | 9/1/98 | 8/30/03 |
New Hampshire | EDS | 2/1/93 | 6/30/01 |
New Jersey | Unisys | 10/1/89 | 11/28/00 |
New Mexico | Consultec Inc. | 12/20/94 | 12/31/01 |
New York | Computer Sciences Corp. | 5/1/91 | 4/30/99 |
North Carolina | EDS | 7/1/89 | 6/30/00 |
North Dakota | State-operated | NA | NA |
Ohio | State-operated | NA | NA |
Oklahoma | Unisys | 7/1/96 | 6/30/03 |
Oregon | State-operated | NA | NA |
Pennsylvania | EDS 6 | 1/1/93 | 6/30/02 |
Rhode Island | EDS | 12/1/92 | 6/30/00 |
South Carolina | State-operated | NA | NA |
South Dakota | State-operated | NA | NA |
Tennessee | EDS | 10/1/95 | 9/30/00 |
Texas | EDS | 9/1/89 | 8/31/98 |
Utah | State-operated | NA | NA |
Vermont | EDS | 7/20/92 | 6/30/01 |
Virginia | First Health Services Corp. | 7/1/88 | 12/31/01 |
Washington | Consultec Inc. | 10/1/89 | 12/31/00 |
Washington, D.C. | First Health Services Corp. | 10/1/92 | 1/31/99 |
West Virginia | Consultec Inc. | 7/1/93 | 6/30/01 |
Wisconsin | EDS | 1/1/92 | 12/31/01 |
Wyoming | Consultec Inc. | 2/1/93 | 6/30/01 |
NA-Not applicable 1-Delta Dent
Source: HCFAes contract. 2-State switching to Consultec after current contract expires. 3-Holds contract expiring Dec. 31. 4-Unisys provides some services.
5-Holds contract expiring Aug. 30. 6-SomeNA-Not applicable 1-Delta Dent
Source: HCFA
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