As a former Medicaid commissioner for the Commonwealth of Kentucky serving under both Democratic and Republican administrations, and against the backdrop of significant cuts to Medicaid in President Trump’s proposed fiscal 2020 budget, I have three clear takeaways from last month’s State Healthcare IT Connect Summit:
- State Medicaid agencies must accelerate efforts to manage and compare Medicaid managed care organizations (MCOs) via population health management platforms.
- Solutions that incorporate social determinants of health (SDoH) must be utilized to risk stratify Medicaid patients and get a better understanding of socioeconomic factors that influence a population’s health.
- To counter the opioid crisis, population health management solutions can be leveraged to promote program integrity and detect fraud and abuse.
The bottom line is that advanced, easy-to-use healthcare IT solutions that combine data integration, analytics and care coordination, can help optimize MCO performance. And as the marketplace processes Medicaid expansion through the lens of President Trump’s budget proposal, states focused on cost savings and efficiency will be better positioned to manage their Medicaid populations.
Using Population Health Management to Compare MCOs
When it comes to tracking MCOs for performance and outcomes, state plan administrators are still struggling with legacy healthcare IT issues, particularly when it comes to selecting which metrics should be used to compare MCOs. Yet, this can be overcome with relative ease via population health management platforms that track MCO performance across the state and for certain patient cohorts. These platforms can evaluate the MCOs they have awarded contracts to and analyze data granularly to see if these MCOs have demonstrated improvement in community health and cost savings.
States will want to independently collect, validate and evaluate these MCO performance metrics using automated processes and available data sources. Comparative analytic tools that can allow for self-generated reports by authorized users and dashboard functionality allow state Medicaid officials to regularly review and parse the data for their needs. Integrated platforms can also be used for MCO report card generation to make desired metrics publicly available and comply with new CMS quality rating system requirements. These tools give members meaningful information to compare plans and provide taxpayers with transparency in the use of public dollars.
Social Determinants of Health
With SDoH solutions embedded in comprehensive population health platforms, MCOs have a unique tool for risk-stratifying their members and developing effective strategies to meet the care needs of patients. By taking a proactive, holistic approach to care and identifying issues related to housing, employment, food security, social and emotional health, and other socioeconomic factors, care coordinators can connect beneficiaries to support services and implement cost-effective plans to address underlying issues affecting health.
While analytics-driven population health management platforms can play an important role in addressing a multitude of healthcare concerns, they are particularly helpful identifying factors driving the opioid epidemic. There are solutions available, or in development, that use analytics and artificial intelligence to identify at-risk people as well as doctors and pharmacies that prescribe and dispense the highest amounts of opioids. Advanced analytical tools can also monitor compliance with medication-assisted treatment protocols and addiction counseling to help those suffering with addiction to participate in treatment. States and their contracted MCOs are increasingly looking for these data-driven solutions to help combat the opioid epidemic.
Advances in healthcare IT innovation are helping states better monitor and solve their most vexing population health concerns, ultimately improving the health of the population and reducing the rate of growth in public expenditures. The summit provided an excellent forum for states and partners to come together to share concerns and discuss solutions.