Vermont Business Magazine eQHealth Solutions, a leader in population health management for commercial and government entities, has developed the first-ever care management technology certified by the Centers for Medicare and Medicaid Services (CMS).
The Certification was given to the Software as a Service (SaaS) solution eQHealth Solutions created for the care management business area of the State of Vermont’s Medicaid program. The newly certified technology is based on eQHealth Solutions’ commercial off the shelf product which currently serves the needs of a wide range of payers in commercial and government-sponsored health plans. CMS offers significant long-term funding on a 90/10 basis for IT projects that are certified to deliver “highly interoperable systems to maximize value and minimize burden on beneficiaries and costs on providers,” and can impose substantial penalties on those that do not meet its criteria.
“Demonstrating that you meet CMS’ strict requirements is a long and arduous process that is challenging for even the largest internal IT departments within state government,” said Sean Marchiafava, Chief Information and Technology Officer at eQHealth Solutions. “It requires a tremendous investment in human and financial resources at a time when states have a huge backlog of essential technology projects to complete. Earning this certification means we can now offer state Medicaid administrators a solution that is already pre-approved and backed by an organization that knows what it takes to achieve it. The result is they can redirect those resources where they belong – serving the Medicaid members in their states – without risking financial penalties.” According to eQHealth leadership, this Certification is expected to create a ripple-effect of efficiencies in the healthcare space as state and commercial payers anticipate and benefit from solutions that uphold the rigorous standards that CMS mandates and eQHealth delivers.
To secure CMS certification, the State of Vermont project had to meet functional requirements of the Medicaid Enterprise Certification Toolkit (MECT), which is a component of the Medicaid Enterprise Certification Lifecycle, including Service Oriented Architecture (SOA), real-time integration capabilities, data dictionaries, HIPAAx12 transaction capabilities, NPPES integration, industry standard business rules engine, role-based security, HITRUST certification requirements, industry standard code and data sets, system performance monitoring, workflow and event driven business processing, strong data analytics and canned and ad-hoc reporting to name a few.
“Population health management is an important factor throughout all of healthcare, but nowhere does it play a larger role than in Medicaid because of its impact on moving from volume to value,” said Glen Golemi, Chief Executive Officer at eQHealth Solutions. “The demand for Medicaid continues to grow while budgets often shrink or remain flat at best, which creates additional pressure on the entire system, especially since the sickest members require more resources. By keeping populations healthier, a state can stretch its budgeted dollars further while actually improving the quality of care. We are grateful to work with a great partner like the State of Vermont, and proud to be the first organization in the country to have its care management technology certified by CMS.”
About eQHealth Solutions
Founded in 1986, eQHealth Solutions is a population health management and technology solutions company that touches millions of lives annually throughout the nation. Our high-tech and high-touch models include innovative technology solutions and care coordination services and focus on outcomes and optimization of provider and payer networks. eQHealth serves a variety of entities including federal, state and commercial clients.