“The benefits under the law are as varied and broad as the marvelous modern medicine itself.”
This was how President Lyndon Johnson described the bill he signed at the Truman Library in Independence, Missouri, that enacted Medicare and Medicaid into law.
To be certain, Medicare and Medicaid represented a great step forward for the American health care system, but the notion of the marvelous modern medicine of 1965 is quaint in the light of the health care we enjoy today.
Today’s technology enables medical practices unimaginable by President Johnson. The care Medicare and Medicaid participants receive today is immeasurably more complex, more comprehensive, and more capable than the medical care of 50 years ago.
Steadily increasing health care costs and the pace of health care innovation create serious challenges for states in administering their Medicaid programs. States that fail to invest in the operational infrastructure of their programs will forego the advantages of medical innovation and waste scarce tax dollars on ineffective care and inefficient administration.
What are the critical Medicaid infrastructure investments states should be making? I believe there are three.
- Health information technology to exploit the immense amounts of data available through electronic medical records and health information networks. Data-driven health analytics help providers avoid treatments that are duplicative, ineffective, or contraindicated. These systems provide powerful tools to analyze policy options and manage the care for citizens with multiple complex chronic conditions.
- Case management systems to process efficiently the vast amount of information needed to determine who is eligible for Medicaid coverage. Modern systems allow data verification to be automated and for documentation to be moved, stored, and audited electronically greatly lowering states’ operating costs while also improving security. Modern computer architecture allows citizens to use the internet or their phones to conveniently and quickly apply for service and manage their cases.
- Medicaid professionals: It is essential that states give their Medicaid agencies the resources and flexibility to attract, retain, and fairly compensate a diverse team of skilled professionals. Medical professionals and technologists are essential in developing health care policy founded on the best current medical evidence. Contract managers and attorneys are needed to hold managed care plans accountable for the care they are paid to deliver. As the American health care system continues its inevitable evolution toward population-based payment models, Medicaid agencies need leaders who understand the complexities of health care finance and who can smoothly transition their Medicaid programs from fee-for-service and managed care to more integrated and efficient payment methodologies.
Computer systems and health care expertise do not come cheap. State budget writers may be prone to dismiss them as extravagant but this would be wrongheaded. These costs must be considered in the context of the billions states spend on their Medicaid programs and as the essential elements of a prudently run health care program that they are.
Judicious investments in the high-caliber talent and tools necessary for a well-run Medicaid program will pay off many times over through controlled costs, positive health care outcomes, and healthier citizens.
HCF supports funding of a state infrastructure that is adequate to administer, maintain, and analyze data from Medicaid programs. This topic is a Tier 2 priority in our 2018-2019 policy agenda. Read more here.