Health Equity for State Government - New Rules, Data and Approaches for 2023

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. This is going to have an impact on all state government agencies. So today we're going to 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 2 experts from Optum in to help us make sense of what's happening. We have Mai-Lynn Tufti, Practice Lead, Population Health for Optum Advisory Services, and Meeta Kreiner, the Practice Lead for Population Health for Optum Advisory Services as well. Mylynn and Meeta, 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, and kind of how you got to where you're at today. And Meeta, 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 Maileen, how about, how about you?

Sure. Thank you. Maileen Tufti. 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 3 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. 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 well-being.

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, Meeta, I'd like to go to you for this. Tell us a little bit about how this is going to impact state governments.

Sure. So, one of the— 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 3 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 3rd one, which is the Health Homes Core Set, and that's for states. And I think I think the last time I looked, it was about 19 states that have a health home program within their Medicaid. So these have all— 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 going to 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 going to look like. It's going to 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, you know, sooner than it might seem.

And I guess—

And—

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 them is clearly it's a focus on national consistency in reporting. While it's been voluntary, you know, states have had a little leeway to use some different methodologies, maybe include different portions of their Medicaid populations, right? Because Medicaid's really a lot of different programs that can look a little different. And so that consistency, that's So that's going to 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 going to mean partnering with providers and managed care organizations to do that work. And the last piece, I think, comes back around to what Mylan was saying, which is there's really, you know, 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 going to get expanded and that whole focus on health equity is just going to keep growing.

You know, you're right in terms of, you know, A, providing a phenomenal breakdown of what's coming, but that it's a quick, relatively quick turnaround. So, Mylan, 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 that, um, of data standards and, and, uh, quality measures, and it's important to have one person that's accountable to do this, um, but it really takes leadership, leadership from the top, um, to understand the importance of these measures And the input from all those stakeholders that Meeta 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 Meeta in Michigan at the time, it may be Meeta, but there's 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? Meeta, 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 2/3 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 pulling together your Medicaid eligibility, claims and encounters, If your physical health and your behavioral health are in 2 different systems, bringing those together, pharmacy. But there's more and more of a focus on health outcomes metrics, you know, that go to that next level. And that means, you know, really data integration. And one of the resources or one of the benefits for state governments is that, you know, Medicaid is just one piece of it, right? And there's also, you know, public health and public health has other datasets 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 got to 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. Another— I think another challenge with that is even with that resource of your public health outcomes data, a lot of these metrics are still looking for clinical data, and that can be really challenging for 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 dataset. 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 Mailin, 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 Meeta 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. Meeta 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 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 want to 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 you just kind of uncovered? Meeta, maybe you could share with us whether it's the people, the process, the technology, what should states be considering now to handle that, both their data, their health equity measurements?

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. 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?

Mm-hmm.

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 going to be playing a role with the data collection. And then it's really important, I think, as sort of Mai-Lynn 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 going to 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, you know, 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 kind of 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, you know, these, 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 access, 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 processes, 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're 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 going to really make a difference.

I love that. I think that that aligns to the mission I know that we have as an organization in terms of making government better. And I think that the health equity, health equity measurement and improving healthcare outcomes is a massive part of that. So, Maileen, I wanna stay with you for a sec. 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 Mita. 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 optimum.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, you might need at your state.

Awesome. Well, Meeta, Mai-Lynn, 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.