Influx of New Medicaid Participants

Millions of unemployed Americans are losing employer-sponsored healthcare coverage. Without income or affordable insurance options, a large percentage of the U.S. population now find themselves eligible for Medicaid, many for the first time in their lives. As state Medicaid agencies and managed care organizations (MCOs) shore up systems to welcome a tsunami of new enrollees, there are three areas to quickly assess: financial, operational and clinical. By using all available state data and resources, programs can be ready for the surge ahead.

Healthcare Innovation recently interviewed HealthEC regarding the rapid influx of new Medicaid participants and how programs should prepare. In this expert interview, HealthEC targets the clinical and care coordination challenges facing Medicaid programs, plans, agencies and MCOs. While the full financial impact of COVID-19 for states and their Medicaid programs has yet to be realized, HealthEC recommends a proactive focus on care coordination and data optimization. Here are seven takeaways from this important executive interview.

– Data aggregation for effective care management has always been a challenge in Medicaid.

– States lack a single set of data to assess quality performance at the provider and participant levels on a real-time basis.

– Old quality data won’t help Medicaid programs identify hot spots or implement new care programs during the COVID-19 pandemic.

– SDOH data also plays a key role to proactively identify and reach out to at-risk members and essential workers during periods of social distancing.

– Consolidation of data, targeted outreach and care coordination services is quickly needed.

– States must take advantage of existing technology to move ahead with predictive analytics.

– HIEs may provide a partial solution, but other data sources at the state level are required.

HealthEC’s final advice for state Medicaid programs is to stop pontificating about technological approaches and begin “practical application of existing data and analytics at the state level to address specific policy initiatives, member needs and gaps in care.” Hear the full interview with HealthEC and Mark Hagland, Editor-in-Chief, Healthcare Innovation here.