Get creative with technology to drive your managed care programs

There has never been a more exciting time to work in health care. Technology innovation coupled with the shift to value-based care and a focus on social determinants of health (SDOH) has helped create a new healthcare system that is less costly, more effective, and better for providers and patients alike. 

The more we understand SDOH the more we recognize the enormous effect they have on access to healthcare for ever-growing segments of our society, including those living in poverty, those lacking reliable transportation and those experiencing housing insecurity. Although these challenges may seem daunting, technology and human innovation is driving progress forward. 

Consider the example of rideshare services. Both Uber and Lyft have partnered with hundreds of healthcare organizations to eliminate transportation barriers for patients who lack transportation to get to healthcare appointments and other healthcare services. Providers linked with these special rideshare programs can schedule rides to and from appointments for patients via an online portal. Participating providers see costly no-shows and last-minute reschedules decrease, while treatment adherence, clinical outcomes and patient satisfaction increase. 

The use of electronic health records (EHRs) also has brought greater proficiency and effectiveness to the healthcare industry by easing the flow of patient information within health systems to reduce care duplication, improve communication, and increase efficiency. The next big opportunity will come from taking all the available data across healthcare entities and turning it into actionable form directly within a workflow, such as an alert during a routine office visit to schedule a patient’s annual mammogram before she leaves. This will help drive out variations in care, eliminate waste, and ultimately improve patient outcomes. 

In parallel, new value-based care arrangements, such as Managed Medicaid programs, are showing success as they become more prevalent. Additionally, over the past few years, Medicaid beneficiaries have exceeded the 20 million members participating in Medicare Advantage, becoming the fastest-growing group of health plan members. According to a McKinsey and Company report,  Medicaid expansion adults—the fastest-growing segment—increased Medicaid enrollment by about 27.5 percent from 2013 to 2018. In 2018, Medicaid was a $629 billion program covering about 73 million beneficiaries.

Understanding the challenges, healthcare payer and provider organizations need to create a customer-centric Managed Medicaid with a focus on providing comprehensive care coordination that addresses members’ physical and behavioral health and long-term care needs. Using a personalized model of care, organizations can take into consideration housing and members’ preferences related to other needs. In addition, using network contracting and utilization management systems, organizations can squeeze out low-value care and improve the health of beneficiaries. With a strong focus on primary care that accounts for SDOH, healthcare payers and providers can incorporate innovative services, such as life coaches and transportation, to make a significant, positive impact on vulnerable populations. 

From providing day-to-day care for a variety of populations to continuously improving evidenced-based care management to community-based wellness programs, the new health care environment will deliver on the promise of higher quality care at lower cost.