Article archive / January 1, 2014
Originally published: . Volume 5, No. 5. Source pages: 3.
In a December Request for Innovations, Bill Perkins, Project Director for Medicaid Modernization, asked for ideas regarding improvements to the Louisiana Medicaid system. The Bureau of Health Services Financing (BHSF) under DHH is the administrative agency responsible for the Medicaid program. Currently, approximately 1.4 million people are enrolled in Medicaid in Louisiana, according to the communication.
Perkins listed technical components that vendors might offer ideas about, which included components: Asset Verification, Business rules engine, Call center, Case management, Clinical program integrity, Clinical quality assurance and management, Configuration management/rules engine, Data warehouse, Document management, Electronic Health Record, and many other components. Perkins also wrote that the policies, procedures, and standards related to these components would also be central to success.
“The focus of this RFI,” wrote Perkins, “is to learn about innovative ways of managing all aspects Medicaid from business processes to the systems that support our efforts. Currently, the fiscal intermediary manages both the core functions of claims processing as well as a whole host of clinical management aspects. DHH is interested in modernizing these functions, organizational approach, and evaluating the ways in which they can be executed including whether they can and should be done by separate entities.”
Perkins also wrote that the long-term vision of the project is to “cultivate a healthcare economy that promotes health outcomes and where business and information technology (IT) assets and resources are cost- effectively managed across the Medicaid Enterprise.”
The memo noted that in 2013 approximately 42.4 million Fee-for-Service Medicaid claims were processed and approved for a total of nearly $5.6 billion in provider payments. An additional 16.2 million encounter claims were received from the three Managed Care Organizations operating Bayou Health and the Prepaid Inpatient Health Plan (PIHP) operating the Louisiana Behavioral Health Partnership.
One of the keys, wrote Perkins, is the implementation of a “centralized architectural strategy.” He said that the architecture “is the prerequisite to implement systems which can communicate effectively, reduce the time and cost required for system changes, minimize the cost of service delivery and maintenance and provide consolidated analytics for informed decision making.”
Vendors are to respond by close of business on January 31, 2014. The notice said that the Request for Innovation is for planning purposes only and is not a Request for Proposal (RFP).
In a related story, the Louisiana Legislative auditor, Daryl Purpera, released a report in October 2013 noting that DHH paid approximately $1.85 million in participant feed for 1,727 deceased individuals in the Louisiana Behavioral Health Partnership and Bayou Health programs between February 2012 and June 2013.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.