Optum teams with Medecision, TriZetto to add population health capabilities to Medicaid Management Information Systems
Optum has partnered with Medecision and TriZetto to deliver a new platform for Medicaid Management Information Systems that brings features specifically for population health management.
Called Optum Medicaid Management Services (OMMS), the new platform is available via a software-as-a-service (SaaS) and business process-as-a-service (BPaaS) model that incorporates Aerial, Medecision’s population health management tools, and TriZetto’s broad Medicaid claims and administrative platform named Facets.
The Optum solution provides states with business services, such as Medicaid fee-for-service claims processing, care provider enrollment, call center activities and operations reporting; analytics and data warehousing services that can use data to help states identify needs across their population, focus resources accordingly to improve outcomes, and measure the performance of care providers, health plans and new state-managed programs to improve care; and health services such as wellness and care management programs to improve the health of Medicaid fee-for-service recipients.
The companies said states that purchase services instead of setting systems requirements can benefit with shortened IT implementation period with less cost and reduced risk; more choices from proven commercial solutions; improved administrative operations; and access to new technologies and cloud-based approaches that help agencies operate more flexibly.
Optum estimates that its SaaS approach could cut by as much as half the timeframe for new MMIS implementations, thereby significantly reducing the time and cost of implementation, and containing operational costs in both the short and long term.
Traditionally, MMIS systems – which process Medicaid fee-for-service claims and managed care encounters, and provide reporting on the program – are formally certified by the Centers for Medicare and Medicaid Services. Such certification enables states to access enhanced matching federal funds at the rate of 90 percent for design, development and implementation, and 75 percent for operational expenses.
The companies said that in conjunction with the launch of OMMS Optum has received certification from CMS as a Quality Improvement Organization (QIO)” entity, a designation that enables it to perform quality improvement initiatives, and review cases and analyze patterns of care related to quality measures and medical necessity. The QIO-like designation allows states to receive 75 percent federal matching funds when Optum performs these services.
“The Optum solution is analogous to states purchasing the electricity they need rather than building the entire power plant,” Optum executive vice president Steve Larsen said in a statement. “Our state Medicaid clients have told us that traditional MMIS program administration approaches – now more than three decades old – needed upgrading to reflect the fast-paced environment and their broadened responsibilities under the Affordable Care Act.”
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