Can you imagine a world where Medicaid isn’t just a lifeline for those in need but a force driving outcomes that transform lives? That vision is no longer a distant dream; it’s a reality that demands our attention.
Medicaid programs make thousands of policy decisions each year that affect some of the most at-risk, in-need and voiceless among us. Take babies, for example. Medicaid covers one in four babies born in the US. Millions living with disabilities are waiting for essential long-term support.
Gone are the days when Medicaid footed the bill for services rendered. It is instead becoming a “buyer of outcomes." However, Medicaid still must ensure that our most vulnerable populations have access to critical services and support. Creating policies to safeguard and elevate those populations is complex work that requires willing partners across payers, providers and community organizations.
To help those in need, Medicaid leaders are focusing on data and analytics to help the program achieve value and advance health equity.
This transformation is steering state Medicaid programs toward strategic partnerships with managed care organizations (MCOs) to improve value for the members they serve. Now, over two-thirds of the estimated 93 million Medicaid enrollees receive most of their health care through risk-based MCOs. With billions of dollars spent to manage care, states ask what they are getting for their money and how health outcomes are improving.
Amid this sea of change, there are three strategies I’ve seen that use data to help state Medicaid leaders “buy outcomes” through Medicaid-managed care and offer a collective challenge for us all:
1. Implementing proactive oversight through data visualization
Implementing proactive oversight through data visualization begins with understanding the factors influencing health equity. This is the first step in driving change or introducing alternative treatment methods.
State Medicaid programs are using analytical tools to get insights into the needs of members. This means understanding interconnected elements, such as specific diagnoses, social vulnerability, general economics, provider availability and geographic risk factors. Streamlined and accessible dashboards are being developed that provide an ongoing longitudinal view across utilization by MCO, provider and geographies. These dashboards quickly provide valuable insights into outcomes, cost and potential gaps in care.
2. Using data to embody whole person care
It is well documented that two-thirds of what affects a person’s or community’s outcomes has nothing to do with what happens at a doctor’s office. Given the importance of Medicaid programs, states are constantly looking for solutions to ensure that the proper care and social support are provided at the right time and at the right cost.
With increasing regulatory flexibility and incentives from the Centers for Medicare and Medicaid Services (CMS), Medicaid leaders are looking across health and non-health data. This approach helps them gain a holistic view of members’ needs, pinpoint where health disparities and inequities persist and design delivery of care models that meet members where they are.
For example, states are encouraging MCOs to use novel data sources such as state health information exchanges and social determinants of health to gain rich insights into clinical care needs and key factors driving potential gaps in care, such as missed immunizations or inaccessible long-term support services.
3. Advocating for change through data-driven policy
Advanced analytics is helping health care organizations reveal the trends in health data to inform evidence-based decisions and data-driven policy for Medicaid. This helps those organizations incentivize outcomes through MCO contracts.
State leaders have recognized the need to collect, manage and analyze data effectively to make decisions. Because of that, leaders are looking for ethical, transparent analytical models that help them predict future population health needs, streamline health care operations, improve data quality and optimize financial management to improve beneficiary results. In this process, state leaders also must balance competing program priorities and limited resources. So, as leaders strive to make data-driven decisions, adept management of data assets becomes more important.
A challenge for leaders
My challenge to state leaders nationwide is to devote time to understanding what’s possible with advanced analytics. Odds are that your state has room to grow in applying the latest tools available today. Don’t just rely on your MCO partners to manage your members. Complement MCO analytic efforts, not just to provide oversight, but to plan members’ needs strategically.
With quality data and the latest analytical tools, you can better oversee MCOs, manage program costs, identify waste and constantly adapt to meet your members' complex and evolving needs. In turn, more children will have access to services and individuals living with disabilities can lead more fulfilling lives through targeted services in the community.