The Medicaid program provides health insurance to more than 67 million Americans, including low-income children and parents, elderly individuals, individuals with disabilities, and adults without dependent children. These individuals have very diverse, and often complex, health care needs, exacerbated by social determinants of health, such as access to safe and affordable housing, healthy food and safe neighborhoods. In 2016, over two thirds (68.1 percent) of all Medicaid beneficiaries were enrolled in comprehensive managed care organizations (MCOs), 6.7 percent were enrolled in Primary Care Case Management (PCCM) entities, 14 percent were enrolled in Behavioral Health Organizations (BHOs), 16.7 percent were enrolled in non-emergency transportation plans, and 8.3 percent were enrolled in managed dental programs. With this increase in managed care coverage, more onus is being placed on Medicaid health plans and providers to achieve greater health outcomes, and to tie payment to quality.

Research presented at the AcademyHealth Annual Research Meeting (ARM) in June 2018 showed that investments in population health (e.g., social, behavioral, and environmental factors) can help improve health and reduce spending on hospitalizations and other avoidable care. One study looked at whether providing wraparound services, such as dietetics, social workers, legal and financial services, and behavioral health services, provided to adults by a large urban Federally Qualified Health Center (FQHC) network was effective in reducing costly hospital care. The study found that the receipt of wraparound services consisting of a myriad of non-medical interventions to address social determinants of health was associated with an 18 percent reduction in the number of expected hospitalizations in the year following receipt of wraparound services. The author of the study noted that while providing wraparound services may be a viable tool to reduce health care cost, since such services are not generally reimbursed, it is difficult to fully assess the financial impact.

Equally as important as providing wraparound services, is how to communicate with beneficiaries about the availability of such services and empower them to become eager participants in improving their health – a topic well represented at the ARM conference. What was apparent from the research is that while there are multiple ways to engage patients, innovation in this area has a long way to go – especially when it comes to the Medicaid population. Given the complex health and social characteristics of Medicaid enrollees and the variation in delivery systems utilized by states, meaningful impacts on population health can only be achieved if providers across a broad spectrum of health and social services have a holistic view of the individuals to whom they provide care and supports, and consumers have the resources and access to their health information to be more engaged in managing their health. Unfortunately, states often have fragmented systems that are not interoperable, preventing them from tracking, coordinating, and providing a record of a beneficiary’s overall health and social service needs and encounters. How best to leverage patient data to improve the quality of care and empower patients is an ongoing challenge, and this is especially true in Medicaid.

Earlier this year, Seema Verma, Administrator for the Centers for Medicare and Medicaid Services (CMS), announced the MyHealthEData Initiative to help patients better engage in their health care. As part of the initiative, CMS launched the Blue Button 2.0” tool. Since 2010 Medicare beneficiaries have been able to use Blue Button to download a file of their personal health information. Blue Button 2.0 is an API, which is a set of protocols used by programmers to create applications for a specific operating system or to interface between the different modules of an application. This will enhance the utility of the service by enabling Medicare beneficiaries to download their health information in a useable format, share health information with their doctors, and connect their health information to tools such as mobile applications and computer programs they may currently use and trust to organize and track information to manage their health.

Blue Button 2.0 provides an opportunity to think about how this tool can be leveraged for the Medicaid program. Due to the diverse and vulnerable populations served by the Medicaid program and state flexibility in the design of their Medicaid programs, if CMS considers applying Blue Button to Medicaid data, doing so will require flexible tailoring of Blue Button to meet unique state needs. In addition, because many Medicaid beneficiaries access non-medical services from multiple entities, including state agencies, providers, health plans, and community-based organizations, thought should be given to integration of non-medical human services information and encounters into the health records available to Medicaid beneficiaries through Blue Button. 

In 2017, MITRE started an initiative to address the need for a more comprehensive health record that includes more than traditional medical encounters through the Standard Health Record (SHR) collaborative. The SHR specification will contain all information critical to patient identification, emergency care and primary care, as well as address the dynamic needs of patients over the course of their life by capturing many areas related to social determinants of health. More information on the impact of the SHR can be found at https://health.mitre.org/blog/standard-health-records/.  

As CMS looks toward the future of the MyHealthEData initiatives and further iterations of Blue Button, it can consider how to work with states to develop a comprehensive electronic health record that encompasses both medical and human service encounters that beneficiaries can access and share with all their providers. This could lead to greater integration and collaboration between state health and human services agencies and providers, and consolidated data to inform best practices for case management and care coordination for individuals accessing services from multiple provider types and through multiple avenues. Deploying this holistic data approach can increase beneficiary engagement and reduce services that are duplicative or run counter to treatments or social services the beneficiary is receiving elsewhere.

 

The opinions expressed in this blog post are the author's own and do not necessarily reflect the view of AcademyHealth.

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Rebecca Bruno

Principal Health Systems Analyst - MITRE

Rebecca Bruno is the Principle Health Systems Analyst at MITRE. Read Bio