Whether or not they expanded Medicaid, states are always looking for ways to reduce program costs and improve care for their enrollees. Often, a small number of Medicaid beneficiaries account for a large proportion of the costs – and those same enrollees are the ones who could benefit most from better coordination of their care.
But how can a state actually figure out how to best target their limited resources?
A recent three-part webinar series featuring members of the AcademyHealth State University Partnership Learning Network, as well as leaders from other states, discussed examples of each state’s own experience identifying the target population, implementing interventions, and then evaluating those programs employed to help improve the health of Medicaid enrollees.
Together, participants outlined an approach that both starts and ends with data:
Identification. First and foremost, states need to identify the specific populations or individuals within Medicaid that are driving costs up. Agreeing on the definitions of “high-utilizers”, “high-needs”, and “high-cost” is a critical first step and should not be overlooked. Identification must begin with collecting the pertinent data, including determining what gaps in data availability or quality may hinder the process. Once a state has the necessary data, using analytical and modeling tools to learn who the high-cost Medicaid enrollees are, where they live, and what types of services they are (or aren’t) using will help states focus on targeted interventions.
Intervention. Using the results of predictive modeling and analytics, states can create evidence-based targeted programs to drive specific outcomes. An intervention may be small and local, like a program to reduce emergency department use at an urban hospital, or it may be a large, multifaceted statewide initiative like a birth outcome program to reduce early elective delivery and premature births.
Evaluation. Finally, evaluation efforts bring a state back to data, asking whether the program or initiative is truly reducing costs, creating better health outcomes, and delivering the best return on investment for the Medicaid program. Rapid-cycle evaluation is becoming more common for states to be able to quickly learn whether a particular program is working.
The webinar series is archived here.
About the AcademyHealth’s State-University Partnership Learning Network
The mission of the State-University Partnership Learning Network is to support evidence-based state health policy and practice. To do this, the Learning Network brings together state Medicaid agencies and university research centers to learn from and with one another around specific, partnership defined initiatives. More information about the Learning Network and the webinar slides are available on AcademyHealth’s website.