Creating a Healthier Medicaid Population through Collaboration

Creating a Healthier Medicaid Population through Collaboration

As the largest health care insurer in the nation, Medicaid costs reached $466 billion in 2011, for approximately 60 million beneficiaries. However, less than 5% (2.4 million) of Medicaid beneficiaries accounted for 50% of the total spending in 2011.How best do we arm our future healthcare system with the right information at the right time, in order to empower the best decisions, engage the right collaboration and achieve what the government and managed care organizations (MCOs) supporting Medicaid require? Health reform will create a higher influx of Medicaid patients, as physicians and care givers will need to work within bundled payments or shared savings models, all the while reducing or avoiding costs. By the start of 2014, Medicaid eligibility will expand, due to the impact of the Patient Protection and Affordable Care Act (ACA). With changes through health reform, nearly all nonelderly Americans who have income levels below 133% of the federal poverty level will be covered through their state’s Medicaid program. (2) Common challenges in managing Medicaid beneficiaries include:

  1. Managing Chronic Diseases
  2. Impact of Dual Medical/Behavioral
  3. Reducing ER Usage for Non Emergent Care
  4. Controlling Admissions/Readmissions
  5. Managing Dual Eligibles

With or without health reform, the challenge of managing growing enrollments of Medicaid beneficiaries remains a challenge for all states and their respective agents, managed care plans and state budgets. The answer to the growing challenges is not to continue to short or sever payments to Medicaid providers, but rather to develop clinical integration models that will support collaboration and result in better patient care with reductions in overall costs.

Learn how you can create a healthier Medicaid population through collaboration through the use of analytics.

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