Sure, strong sales and customer retention drive profit success. However, the increased sales and improved customer retention is a product of the business planning that occurs behind the scenes.
Brozyna During the last decade, state Medicaid agencies have embraced managed care as the predominant delivery system. In addition to the goals of reducing cost and improving clinical outcomes, states are looking to more efficiently and effectively deliver care to the roughly These innovative Medicaid managed care models are driving healthcare transformation and, in conjunction with federal incentives, are leading to effective care delivery modalities that may very well extend beyond Medicaid.
It also presents real solutions for addressing some of the key challenges organizations face in managing their Medicaid members. Currently, managed care is the most common Medicaid delivery system, with all states except Alaska and Wyoming having all or a portion of their Medicaid population enrolled in managed care programs, covering more than 50 million recipients nationally.
States have been motivated to move to managed care primarily to control costs, but the expanded availability of federal funding has provided an added incentive. The State Innovation Models SIM Initiative and the Medicaid Innovation Accelerator Program IAP are two federally funded initiatives created to help states overcome the financial burden of implementing innovative infrastructure to support healthcare transformation.
The IAP program complements these efforts and provides additional federal support and tools for improved data integration, quality measurement, peer-to-peer learning, and spreading lessons learned.
Medicaid care coordination strategies include health homes, patient-centered medical homes PCMHsaccountable care organizations ACOsand the integration of behavioral health into primary care. All of these initiatives rely on technologies to create greater clinical integration between providers, facilitate patient engagement, and standardize care delivery.
Given that Medicaid currently covers about one in every five Americans, these challenges must be understood and addressed by providers and payors who wish to continue to serve these populations. Some of these challenges, along with potential strategies to address them, are outlined in the table below.
It may also have the potential to reduce program costs and improve the overall quality of care delivered. However, these goals cannot be achieved unless MCOs are able to create partnerships between providers and payors that can strengthen the delivery of effective, high-quality managed care to the Medicaid population.
The financial and operational challenges for Medicaid MCOs are difficult to overcome, but with proper market insights, patient engagement methodologies, and payor strategies, some key tactics can be used to address the specific issues in each state.
Depending on the circumstances, some of these strategies may be more feasible to implement than others, particularly in regard to cost-sensitive strategies such as IT investments.
Regardless, employing these tactics can help organizations maximize margins from their Medicaid business under the new MCO model and ultimately deliver better care to a population that has traditionally been underserved.Since , the Stanford Advanced Project Management program has been a high-quality leadership and management professional education program for project managers around the world.
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