Data Analytics Helps Medicaid Deliver Better Care for Less Money

By Jennie Echols, PhD, RN

Twenty-eight states have  expanded their Medicaid programs as of January 1, 2015 – and even more may do so before the end of the year. With the Medicaid-eligible population rapidly increasing, it is no longer just an option for industry leaders and experts to work together to support patients better while lowering costs. It is necessary to introduce vital innovation.

“Patients who are not connected with a primary provider and community resources  are more likely to go to the ER, or be readmitted to the hospital.” –Jennie Echols, Ph.D., R.N., program director of Care and Quality Solutions for Xerox
“States can not only serve their patients more cost-effectively, but also promote a healthier population.” — Jennie Echols, program director, Xerox Care and Quality Solutions

The Sixth Annual Medicaid Innovations Conference provided just that opportunity. I left the event with an understanding of how advanced technology can work in tandem with personalized solutions to provide efficient care with a human touch. Predictive analytics can provide the starting point for effective integrated care management teams.

Data Points the Way to Healthy Outcomes

A number of speakers at Medicaid Innovations 2015 discussed recent advancements in predictive analytics capabilities. Using historical data from multiple sources, tools can model and predict which groups of patients are the most likely to return to inpatient or emergency room care, or who are identified as “super-users.” These models can signal to providers which patients will eventually become high-cost  if they do not intervene.

After the most critical patients are identified, it is equally important for them to receive the appropriate type of care, improve clinical outcomes, and simultaneously keep states’ Medicaid costs in check. Discussed at length at Medicaid Innovations 2015 was integrated care management – the idea of including nurses, behavioral health experts, community health workers and even pharmaceutical advisors on teams. These professionals work together  to physicians improve health outcomes for their patients who previously were at critical risk.

Data Identifies Highly Personalized Care

Integrated care management is taken to highly personalized levels. For example, community resources can provide additional support to patients in need. By including public health agencies, local religious institutions, community mental health, and other local support groups, patients can receive the most holistic, comprehensive health plan possible.

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The degree of health literacy of Medicaid patients is often overlooked, but it also represents an opportunity to deliver highly personalized care. In addition to serving clinical needs, providers and care managers can help patients understand their conditions and the behavior changes they may require. Communication with and care for a patient should be optimized specifically with the patient’s level of existing knowledge and health literacy status.

By identifying the most critical patients in expanding Medicaid programs, states can not only serve their patients more cost-effectively, but also promote a healthier population.

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