Indexers from MESH team present at MESC on Medicaid technology

𝑪𝑴𝑺 𝒊𝒔 𝒓𝒂𝒊𝒔𝒊𝒏𝒈 𝒕𝒉𝒆 𝒃𝒂𝒓 𝒐𝒏 𝒎𝒂𝒏𝒂𝒈𝒆𝒅 𝒄𝒂𝒓𝒆 𝒐𝒗𝒆𝒓𝒔𝒊𝒈𝒉𝒕. State Medicaid agencies need faster, clearer visibility across MCO performance without adding operational burden. 𝑮𝒓𝒂𝒚 𝑴𝒂𝒕𝒕𝒆𝒓’𝒔 𝑪𝒐𝒓𝒆𝑻𝒆𝒄𝒉𝒔® 𝒉𝒆𝒍𝒑𝒔 𝒂𝒈𝒆𝒏𝒄𝒊𝒆𝒔:  • Centralize metrics with MeasuresLibrary® (HEDIS®, CMS Core Sets + state customs) for a single source of truth • Automate reporting & compliance with governed specs, versioning, and audit trails • Monitor quality, utilization & TCOC in near real time with proactive alerts • Apply AI (GMA Genius) to predict rising risk and target interventions • Benchmark MCOs and providers to surface best practices and address variation • Cut time-to-insight with an Analytics-as-a-Service model that deploys quickly and scales If you’re preparing for new CMS reporting and oversight, we can help you stay compliant and improve outcomes. 𝑳𝒆𝒕’𝒔 𝒄𝒐𝒏𝒏𝒆𝒄𝒕 𝒕𝒐 𝒘𝒂𝒍𝒌 𝒕𝒉𝒓𝒐𝒖𝒈𝒉 𝒂 𝒍𝒊𝒗𝒆 𝒅𝒆𝒎𝒐. #Medicaid #CMS #ValueBasedCare #HealthcareAnalytics #Compliance #HEDIS #PopulationHealth

At the Medicaid Enterprise Systems Conference last week, federal and state leaders made it clear: the future of Medicaid hinges on smarter, more responsive technology. CMS is embedding policy and IT teams to improve clarity in rulemaking, expanding technical assistance for states, and launching a new APD portal to streamline modernization efforts. As states prepare for major changes like work requirements, the focus must stay on continuity, collaboration, and member experience. Real-time data exchange, AI-powered tools, and interoperable infrastructure aren’t just buzzwords, they’re the building blocks of a new Medicaid system that works for everyone. #MedicaidModernization #PatientCenteredCare #HealthEquity #DigitalHealth #Interoperability #MESC2025

When Blue Cross NC set out to complete organization-wide core consolidation, grow its Medicare business and enter new markets, it faced a major challenge: a 25-year-old legacy system that couldn’t keep up with enrollment demands, compliance needs or member expectations. The health insurer needed a modern solution to streamline operations, reduce manual intervention, and improve member experience—especially during the high-pressure Annual Enrollment Period (AEP). Discover how the organization partnered with Cognizant to migrate 300K+ members to the TriZetto® Facets® core system and Enrollment Administration Manager, achieving: ✅ 85% first-pass enrollment success ✅ 2X increase in AEP enrollment volume ✅ 62% reduction in enrollment transaction fallouts Read the case study: https://cgnz.at/6042snV1o #MedicareAdvantage #HealthcarePayers #DigitalTransformation Cognizant

🚀 When Your IT System Ages Like Vintage Cheese… But You Still Need to Grow Medicare Plans. So, our friends at Blue Cross & Blue Shield of North Carolina did the brave thing: they pulled out their 25-year-old legacy system—think stone tablets and carrier pigeons—and said, “You know what? It’s time for an upgrade.” They migrated 300,000+ senior members to Cognizant’s TriZetto EAM and Facets platform, and magic happened:    •   A whopping 85 % first-pass enrollment rate—no replays!    •   61 % of DTRR fallouts fixed automatically—no human drama.    •   100 % elimination of duplicate CMS DTRRs—because who needs déjà vu in claims? Points for them:    •   Liberated themselves from legacy shackles    •   Streamlined workflows, improved compliance    •   Made it easy for members to get care without a glitch In short: out with the legacy system, in with growth and agility. 🕺 ⸻ Modernize or be left behind—especially when seniors depend on you to actually get their care right. #Elements #MichelMendez

Very interesting insights from CMS - highlighting HITRUST Certification as an element of their Interoperability Framework. While not a mandate, it is clear that the road to health interoperability includes trust. If you have questions related to HITRUST please reach out!

The Centers for Medicare & Medicaid Services (CMS) raised the bar for health data exchange with its new Interoperability Framework that requires validation equivalent to HITRUST certification — a clear signal that secure, trusted interoperability is non-negotiable. HITRUST isn’t just another compliance checkbox. It’s the gold standard for healthcare security. Read more about how HITRUST supports CMS’s vision for trusted interoperability. https://lnkd.in/g-eBhpEz #HealthcareSecurity #CMSInteroperability #SecurityFramework #HealthcareCompliance

Every Medicaid leader is balancing two competing truths: 1. Managed Care oversight is complex, and; 2. Do more with less. That’s why I’m excited to share one of the tools we’ll be talking about at this year’s National Association for Medicaid Program Integrity (NAMPI) Conference: Public Consulting Group's AssuranceCR. Think of AssuranceCR as a compliance and reporting backbone for Managed Care assurance activities. It helps states: > Standardize compliance checks across Plans and regions. > Track trends with leadership dashboards that actually mean something. > Document corrective actions in a way that’s auditable (and less painful). The result? Lower error rates, fewer improper payments, faster resolutions, and higher confidence—for state staff, for Plans, and for the public. In a year where every Medicaid dollar is under the microscope, AssuranceCR helps states move from reactive oversight to proactive assurance. If you’ll be in St. Louis for NAMPI (August 24–27), stop by Booth #27 and let’s talk about how tools like AssuranceCR can make Managed Care oversight less about fire drills and more about confidence. Ask for Patricia Perazzelli, who will be joined by her colleagues Jay Peck (he/his) Hannah Trate Jay Derby, Ph.D. PCG’s Health team #Medicaid #ProgramIntegrity #ManagedCare #FraudPrevention #NAMPI2025 #HealthCareCompliance

CMS Interoperability Rule is reshaping U.S. healthcare. From FHIR APIs to payer-to-payer data exchange, the rule is designed to break down silos, give patients control, and drive innovation. connect with our team for Interoperability training Bapi Behera Biswaranjan Mohanty #healthcareit #cms #fhir #interoperability #cmsinteroperabilityrule #payers #providers

🚨 It was easy to miss, but yesterday the CMS Innovation Center quietly signaled its intent to move forward with a “geographic” ACO model. This isn’t the first time we’ve seen it. CMMI tried to launch a similar model at the end of the first Trump administration, but it faced strong industry pushback and was shelved by the Biden administration. 🔎 How it would work: ·      A geographic entity would be accountable for all traditional Medicare beneficiaries not already aligned to a Medicare ACO. ·      Today, ACOs only take responsibility if a patient gets the plurality of care from their providers—leaving many beneficiaries outside the model. ·      Geo aims to close that “last mile” by assigning accountability for those patients. ⚖️ What’s different this time: ·      The first “Geo” was tied to Direct Contracting and targeted specific metro areas. ·      Now, CMMI is linking it to the AHEAD Model—currently only active in six (politically blue) states. ❓Key questions ahead: ·      Who will take accountability for patients they don’t have a direct relationship with? ·      Will participation be attractive if eligibility is limited to AHEAD states? ·      What flexibility will Geo entities have? ·      And the perennial issues: how will benchmarks be set, and how will savings be generated? Full announcement here: 👉 https://lnkd.in/eWuuHFhR

PROBLEM: The Centers for Medicare & Medicaid Services faced several challenges managing HIPAA forms, participation agreements, and other documentation, including:  🔹 Forms requiring dozens or even hundreds of signatures    🔹 Slow, manual processes taking up valuable staff time  🔹 Off-the-shelf e-signature tools not meeting the agency’s needs    SOLUTION: ESign, a custom-built solution that Tria Federal developed in collaboration with the CMS Innovation Center.    In under a year, CMS:  ✅ Processed 5000+ documents seamlessly  ✅ Saved $100k annually compared to commercial tools  ✅ Met unique bulk counter-signature needs not supported by DocuSign or S-Docs  ✅ Strengthened compliance with full audit logs    OUTCOME: A faster, more cost-effective, and scalable process that freed CMS teams to focus on what matters most: improving patient care.    📖 Read more: https://lnkd.in/eJ66g6WD    #PoweringPossible #DigitalTransformation #GovTech #HealthcareInnovation #FederalEfficiency #CMS #ESign    Tim Borchert Atchut Kanthamani Murali Krishna M Diana Ceban Brian Wagner, MBA Bryce Golwalla  Chris Katkocin Sean Vineyard Ray Khuo Andrew Hand