Driving High Performance: Medicaid Health Intelligence

In this paper, Accenture:

• Reviews the benefits of improved visibility into the overall performance of the Medicaid program.
  
  
• Examines the challenges posed by poor visibility, including the loss of value from data warehouse systems.
  
  
• Discusses how better intelligence helps the agencies address the needs of a growing number of beneficiaries, respond to evolving and complex federal requirements and contain the costs of service delivery.

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:

• Aligns with program needs.
• Connects with advanced analytical capabilities.
• Creates necessary information to support decisions by stakeholders—individuals and doctors; health plans; program policy directors and state Medicaid directors.
  
  

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.