Accenture reviewed the health reform landscape and the potential for improvements in the quality and efficiency of health care, despite serious budget shortfalls facing many states. Health reform initiatives will almost certainly lead to significant Medicaid expansion, creating the need for effective strategies and approaches for managing the health of the Medicaid population.
Improving care for Medicaid’s most expensive beneficiaries can be one of the most effective and sustainable ways to improve the quality and efficiency of the Medicaid program.
In examining the challenges facing Medicaid agencies, Accenture identifies many missed opportunities for Medicaid programs, in part because of gaps in analytic capabilities. The lack of analytics can also hinder Medicaid agencies in evaluating and communicating the value of program challenges. Agencies also lack the staff, tools and management oversight needed to implement programs leading to desired results.
Care management programs require special adaptation in a Medicaid environment:
- The medical, behavioral and social needs of the Medicaid population are complex.
- Coverage is not stable, with the population periodically entering and leaving the program.
- The financial structure of the Medicaid program is also challenging.
An integrated, outcomes-driven model can improve the Medicaid program’s ability to:
- Successfully manage member health.
- Decrease utilization demand and reduced costs.
- Address the needs of the entire Medicaid population.
This would include both fee-for-service and health plan managed beneficiaries across the care continuum—at-risk, acute, chronic and end-of-life.