By now it’s no secret that president-elect Donald Trump intends to vastly restructure our Medicaid Program, meaning that uncertainty is on the horizon for healthcare providers supplying care to over 80 million low-income Americans.
Georgia Congressman Tom Price will lead the US Department of Health and Human Services (HHS) under Trump, with many estimating that Medicaid could soon change from an entitlement program to a “block grant” to cut costs.
Essentially, in a block grant system, more flexibility would be given to state administrators of Medicaid through a set budget. States will decide how they wish to treat their patients, as well as set coverage requirements and what services the money is spent on.
Based on what we’ve seen in VT, NY, and now MA – more Medicaid control and money is likely to be dispersed through an accountable care organization (ACO) model, meaning provider orgs will be on the hook to provide care that is streamlined, coordinated, and lower-cost.
It is critical that organizations serving Medicaid populations learn to focus their limited resources on the members most likely to benefit. This will be necessary for countless decisions, i.e. deciding who should receive home visits, telemedicine, certain prescriptions, procedures, etc.
Ultimately, success in our Medicaid system may come down to this: Those that can use their data to learn exactly where to focus will be the winners.
However, one-size-fits all analytics or risk scores won’t begin to address necessary challenges, such as which pre-diabetics are headed toward full-blown diabetes, or which patients belong in different Medicaid rating categories.
And yet, these areas are the ones that need to be most understood to deliver high quality care to patients in need. Further, we need to demonstrate to the entire country via these block grants that we can make value-based care work to fend off any efforts to reverse value-based progress.
This is exactly why Cyft has placed particular focus on helping Medicaid care providers; and exactly why our approach has had such a tremendous impact on the organizations we’re working with.
Here are several ways in which we’re helping:
- Optimized Risk Management
We start by focusing on the risk stratification of a plan – making sure the more complex patients are recognized as such. This immediately helps our customers realize appropriate resources for the complex care they’re already delivering. The ability to produce real ROI, really fast (despite the idiosyncrasies of each state’s policies) opens the door for us to then get the right care to the right members.
- Precision Case Management
Next, we help match members to the available specific interventions they’re most likely to benefit from. In the Medicaid world, “one size fits all” risk scores don’t apply. So we’re using all our partners’ data – from call center notes to case management data to ADLs – to steer case managers to patients with the costliest chronic diseases (e.g. diabetes, COPD, hypertension, heart failure, etc.) that are most likely to have preventable utilization – better, more efficient care, faster.
- Member Satisfaction
Finally, we’re helping organizations use all their data to identify exactly which members are likely to dis-enroll and the top reasons why. This has literally transformed our partners’ customer support efforts from reactive to proactive. And because Cyft learns with each new data point, we’re constantly discovering new opportunities as different threats to dissatisfaction are identified and eliminated. This has led to record high member satisfaction and record low disenrollment for our customers.