Alicia C. Smith

This Quality Assurance Performance Improvement (QAPI) Guide outlines the framework for continuous quality improvement within the organization. Its core purpose is to be innovative in enhancing the health, quality of life, and care for South Carolinians, guided by data-driven decision-making, an inclusive QAPI committee, and measurable goals. Key focus areas include member satisfaction, quality of care and services, and overall quality of life, with activities integrated across diverse service areas such as Managed Care, Behavioral Health, and Community Long-term Care. The guide emphasizes identifying systemic issues, developing corrective actions, and implementing Performance Improvement Projects (PIPs) to ensure sustained excellence and member-directed care.

This document provides a comprehensive analysis of transportation performance metrics, tracking data points such as the number of unduplicated beneficiaries, total trips provided by category (sedan/van, wheelchair, stretcher), total miles, and service performance measurements including on-time pickup and delivery percentages for both A and B legs of trips. The report also monitors complaint raw data and resolution percentages.

The document outlines the South Carolina Department of Health and Human Services' (SCDHHS) Medicaid Enterprise System (MES) modernization roadmap. This strategy focuses on decommissioning the legacy MMIS system and transitioning to a modular, scalable solution to enhance Medicaid services. The plan's key goals include optimizing member experience, supporting effective service delivery, improving operational efficiencies, providing data-driven insights, and responding to changing needs. These objectives are addressed through six key initiative areas: managing modernization efforts, optimizing Medicaid managed care capabilities, enhancing member experience, innovating with data, integrating the MES, and managing applications in the cloud.

This document outlines the South Carolina Department of Health and Human Services' Medicaid Enterprise System (MES) Modernization Roadmap. It focuses on updating and improving the technology infrastructure and capabilities supporting the State's Medicaid programs and operations by addressing current gaps and implementing recommendations through seventeen workstreams across five key initiatives: Manage Modernization, Optimize Medicaid Managed Care, Innovate with Data, Integrate the Medicaid Enterprise System, and Manage Applications in the Cloud. The plan aims to align with broader business transformation goals, accelerate the transition to a managed care model, and maximize the value of care and services to improve the health and quality of life for South Carolinians.

This Future State Assessment Summary Report outlines the strategic direction for the Medicaid Enterprise System (MES) Modernization of the SC Department of Health and Human Services (SCDHHS). It encompasses a vision for transforming Medicaid systems and business processes, driven by key imperatives, and informed by market insights. The report details foundational and enabling future state capabilities, general system design recommendations, and an alternatives analysis for core MES components, MMIS, and the Phoenix system. The ultimate goal is to improve the quality of life for South Carolinians by leveraging modern, agile technologies, data-driven insights, enhanced operational efficiencies, and optimized member experiences in service delivery.