Customers looking for authenticity at MESC
I’ll admit it… I’m a policy nerd. Always have been and always plan to be one. As Popeye the sailor famously said, “I yam what I yam.” And I am more than ok with that. Conferences always evoke policy-riddled-optimistic-expectations for me combined with anticipation of seeing how our company stacks up to our industry peers (not that we have any *tongue in cheek shameless plug*). You mix all of that up with some late-night fear of missing out (FOMO) networking sessions and you have all the making of a pretty solid conference. This was my first Medicaid Enterprise Systems Conference (MESC) event, but it certainly will not be my last.
We, along with more than 2,500 people, attended the 2026 Medicaid Enterprise Systems Conference (MESC) held from August 17–20 in Portland, Oregon. MESC is usually held the week before the National Association of Medicaid Program Integrity (NAMPI) conference. The MESC conference featured nearly 100 educational sessions, specialized workshops and CMS-led presentations. Most of the agenda, as the name suggests, focused mainly on aligning Medicaid policy with rapid technology shifts.
With so many agenda items to choose from, how does one pick from things like: Artificial Intelligence in Medicaid, the 2027 interoperability mandate, modular enterprise evolutions, program integrity and fraud, integrated eligibility and enrollment, or data-driven analytics? Luckily for me, I had some seasoned Qlarant teammates that helped make sense of the aggressive Medicaid packed agenda to help prioritize what made the most sense for us to attend in between manning a well-trafficked both.
Interestingly, MESC held a CMS and territories pre-conference meeting the day before on August 16th where federal officials and territorial leadership engaged in a direct dialogue regarding specific technical and operational roadmap updates. Four areas were covered specifically: interoperability standards and prior authorization; evolving funding and system modernization; reporting, compliance and fiscal mitigation; and technical roadmap and program integrity.
Once the main conference kicked off, there was a topic for almost anyone’s interest. This year, some of the more notable individual MESC sessions covered a variety of topics impacting State Medicaid enterprise areas such as change management, policy-as-Code Workflow, Safe AI in Medicaid Alliance (SAMA) framework, and behavioral health mapping. Usually, at these conferences there are States looking for the opportunity to showcase progress they have made in specific areas touting their partners that helped them make it happen. The Colorado Department of Health Care Policy and Financing (HCPF) was no exception as they presented a case study on its Medicaid Program Integrity transformation.
Colorado demonstrated how it successfully shifted from traditional, reactive “pay and chase” auditing to proactive, prepayment prevention in direct alignment with the latest CMS directives.
Colorado shared their “transformational blueprint” for other States in straight forward terms. Colorado wanted to find an answer to the challenge they had which was a massive $25 million fraud spike in non-emergency medical transportation. Colorado realized it was not doing enough, and its monolithic system simply could not react quickly enough. The State decided to separate its program integrity capabilities into an independent, flexible module. The next step was shifting intervention upstream by integrating advanced predictive modeling directly into its active workflow and moving away from trying to claw back misspent funds months after the fact. This is where things got interesting for me. Colorado decided to focus on “explainable AI”? What is this, you ask? Same here. Basically, explainable AI is an attempt at satisfying federal equity guidelines that ensure when the State’s system flags a claim or a provider for potential fraud that the underlying data and logic are clear and legally defensible. This allows the State to avoid arbitrary denials.
I found MESC fascinating. There were so many capable vendors and ambitious technology companies there. In spite of all of the talk about technology and AI and interoperability, one of the most profound things I heard repeatedly was States looking for companies that were authentic, had integrity, focused on quality, and could be trusted.
Qlarant’s 53 years of existence did not happen by chance. It happened and continues to thrive due to all the amazing work our associates do daily while keeping our core values front and center. Our future customers were looking for authentic companies that knew who they were and what they stood for. Qlarant was precisely where we needed to be.
As we were leaving MESC with a potential customer lead, it dawned on me just how right Popeye was all along. Qlarant is what it is not only because of the work we do, but most importantly, because of what we stand for. And in this current environment of AI slop and a proliferation of unreliable content, true and tested experience grounded in integrity is in high demand.
