By Sarah C. Threnhauser, MPA
I think that the executives managing Medicaid programs have one of the toughest jobs in the field. All the regulations, the state and federal political factors, the budget pressures, and the changing factors affecting health care costs and utilization make “success” a moving target.
Medicaid is of growing importance to the U.S. health care system—with 19% of the population covered under Medicaid. So, when Medicaid executives make big changes in their program, the impact is substantial—on consumers, families, advocates, professionals, provider organization executives, and health plan managers. So how do Medicaid directors think about the system change and about improving quality and managing budgets? To answer that question, we turned to Linda Zeller, currently the Senior Behavioral Health Fellow of the Michigan Health Endowment Fund and formerly Michigan’s Deputy Director for the Behavioral Health and Developmental Disabilities.
Her take? Decisions about Medicaid policy and practice are increasingly made using analytics. And, those analytics are changing along with the tools for analyzing large data sets that include capturing data, data storage, data analysis, search, sharing, transfer, visualization, querying, updating, and information privacy (see From Big Data, To Smart Data, To Managing With Data).
But even with data, we’ve seen organizations struggle to turn that information into a meaningful strategy or operational practice. Many organizations lack the digital dexterity to yield results, and when compared to other industries, health care struggles with preparedness for disruptive business models (see Crossing The Digital Health Chasm). What are the biggest impediments that Ms. Zeller has seen, to using data analytics to manage care for the complex consumer population? How has she seen state Medicaid plans, health plans, and provider organizations working to address these challenges?
The challenge is targeting what we need to look at and not being overwhelmed by the amount of data. It’s easy to lose sight of the purpose and focus. And now that so much of Medicaid coverage is managed by health plans, there is also a challenge at the health plan level of synthesizing Medicaid and Medicare data. Until Medicare and Managed Care Advantage Plan data is available in a parallel format to Medicaid data, we are going to have a really hard time using that data. You need both data sets to really understand what is happening at the consumer level.
There is a lot of investment going into innovation in health care space—both among traditional provider organizations and in new start-up organizations. The leaders of these organizations are trying to understand how State Medicaid directors look at innovation and new service delivery approaches. Ms. Zeller provided some insight into innovation at the state level:
I think we are going to see a move at the Medicaid program level to a real population health model. We’ll see more of a focus on prevention and early intervention. And a focus on specific targeted populations with a subset of strategies for different populations, including addressing the social determinants of health (SDH). This will shift the interest of Medicaid Directors to how systems of care can work better within Medicaid.
A great example is homelessness. We have continued to struggle to get our homeless management information systems to connect with the Medicaid claims data. When we did, we saw a high correlation of those without housing who also had psychiatric inpatient or addiction related residential inpatient. This is a nontraditional data source for a Medicaid Director to use, but that is something I think they increasingly want to happen.
To learn more about the specific Medicaid initiatives in every state, check our 50-state profile series—the OPEN MINDS State Medicaid System Profiles and the OPEN MINDS Behavioral Health System State Profiles. Each profile includes detailed information about health care coverage; managed care programs and benefits; care coordination initiatives; health homes and medical homes; and dual eligible care management.
And for more on her work in Michigan, join Ms. Zeller on June 5 at The OPEN MINDS Strategy & Innovation Institute for her keynote address, “Harnessing The Power Of Analytics To Create Innovative Solutions For Complex Consumers.
