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Accenture examines how new ways of looking at data can help Medicaid agencies gain a better understanding of the Medicaid environment and population.
In this paper, Accenture:
The paper begins with a discussion of Medicaid’s existing data warehouse and analytic engines, which are not designed to support the needs of the future. Improved visibility into performance helps programs identify opportunities for improving outcomes and reducing costs. Improved intelligence also helps demonstrate the potential value of program changes.
Medicaid data warehouse systems are not effectively integrated with the vision and goals of the program. It can be difficult to manage and track disparate data sources, and it is also challenging to integrate data from a wide variety of source systems. Lack of data, or poor data, can limit the type and level of analysis that can be performed.
Accenture also looks at the benefits of a comprehensive approach to using health care analytics to create business and economic value. Medicaid agencies can achieve performance by building a foundation of data that:
Getting the data and analytical tools into the hands of decision makers helps identify what aspects of the program are working and where improvements are needed. Clinical and program staff must have real-time insight into program data.
Analytic capabilities can help Medicaid agencies improve program performance by assessing and addressing a broad range of performance indicators, including service delivery, outreach, service pricing, care management, provider reimbursement and performance management. Accenture can help Medicaid agencies obtain meaningful, relevant information from their current system in order to optimize Medicaid spending, regardless of the maturity of the existing analytical model.
A framework combining multiple data—from providers and third parties, as well as the behavior patterns of members—with sophisticated analytics can improve every aspect of a state’s Medicaid program and related decision-making processes. Solutions must reflect organizational complexity and regulatory structure while aligning with recognized health information standards.
The improved flow of business intelligence should help agencies evaluate and improve program performance, manage member health, investigate fraud and abuse and realize federal and state health reform goals.
August 11, 2009
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