Outcomes-Based Certification – Coming to a Module Near You!

By Charlie Goldberg, a Director, HealthEC
Twitter: @HealthEC_LLC

Upon returning home from last month’s Medicaid Enterprise Systems Conference in Chicago, I took the opportunity to reflect on how things have changed since attending the conference in 2002 and how CMS, states and vendors continue to face many of the same challenges year after year. While I could write an entire blog series, if not a book, on “then versus now,” two major themes emerged at the conference, among others to be explored in upcoming blogs:

1. Measure what matters – Venture capitalist and author John Doerr was the opening plenary session speaker, along with Julie Boughn, CMS. John introduced the audience to what has been a proven approach to operating excellence – Objectives and Key Results (OKRs). While, historically Medicaid Enterprise systems and modules have been evaluated based on whether they meet a set of technical operating requirements, states will be required to develop a set of system objectives and determine whether the software is performing in a manner that achieves the key results required to successfully achieve state objectives.

2. Certification based on system and module operating outcomes – At the end of the day, CMS funds 90% of all Design, Development and Implementation efforts, and federal regulations dictate that: 1) a state request for funding (advance planning document) be submitted and approved, and 2) once a system or module goes live, it must be certified in order to receive the enhanced federal match back to day one and going forward.

I attended a CMS session that presented the results of the outcomes-based certification pilot conducted for the Electronic Visit Verification module in Ohio. The amount of reduced effort in terms of hours expended was quite impressive. CMS looked at the hours required using the “classic”certification process and concluded that 8,750 hours would have been required among the state, the IV&V vendor, and the module vendor. In comparison, a total of only 900 hours, distributed among all three vendors, was required to achieve an outcomes-based certification, and that is for just one module! We’re talking about savings in the millions, not to mention the availability of more time by states to use those hours saved on other important initiatives.

So, as if often said these days, watch this space. If CMS and states are successful in implementing the OKR model, we’ll likely be discussing additional innovations at upcoming conferences, made possible by utilizing the time we used to spend on tasks such as certification.

This article was originally published on HealthEC and is republished here with permission.