State Medicaid agency, Medicaid Community and a Field of Dreams
August 07, 2019April 10, 2024
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State Medicaid agency, Medicaid Community and a Field of Dreams

Remember the baseball movie Field of Dreams?

You know,“If you build it, they will come.”

Well, HealthEC hasn’t constructed a ball park in an Iowa cornfield where the ghosts of baseball legends play, but we have built an innovative population health management platform that state Medicaid agencies can use for some pretty otherworldly stuff.

And they are coming … That is, state Medicaid agencies are coming to our platform.

The Department of Health Care Finance (DHCF), Washington D.C.’s state Medicaid agency, partnered with HealthEC in 2017 to develop an enterprise data warehouse (EDW) and use modernized data infrastructure and analytics tools to evaluate the performance of managed care organizations across financial and utilization metrics, assess quality scores, and facilitate care coordination solutions for patients with three or more chronic conditions.

HealthEC migrated, scrubbed, crosswalked, and normalized 10 years of Washington D.C.’s Medicaid data for ingestion and aggregation in the EDW. HealthEC also helped position the EDW as the central data access portal for the D.C. provider community and state health information exchange.

DHCF’s EDW was constructed, implemented, and certifi­ed by CMS for reuse in less than five months, enabling DHCF to drive policy changes as well as provide the necessary framework for other state Medicaid agencies to develop their own EDWs.

The DHCF EDW is now able to track the distribution of 51,000 qualifying benefi­ciaries across Washington D.C.’s 10 chronic condition health homes, identify bene­ficiaries that are eligible for the District’s My Health GPS program, track provider staffing against a required threshold by acuity, and document DHCF communications with bene­ficiaries.

Further, the processes developed by DHCF and HealthEC now give DHCF the ability to:

  • Track defined patient cohorts
  • Categorize patients by acuity and document changes in patient outcomes and costs with added communications/interventions and beneficiaries.
  • Track the performance and delivery of care by MCOs to their attributed populations
  • Compare performance between MCOs in near real time
  • Track fee-for-service Medicaid patients that typically aren’t included in MCO agreements

HealthEC is excited about DHCF’s progress and we look forward to speaking more with the Medicaid community about how we are helping healthcare agencies transition to population health management and value-based care.