Navigating value-based care in Medicaid

Value-based care is a healthcare trend that isn't going away. Without a robust IT infrastructure, however, the concept is much less likely to deliver the anticipated economic benefits and improved patient outcomes. As states evolve and modernize their Medicaid Management Information Systems to next-generation Medicaid Enterprise Systems, they must focus on three important areas of their IT infrastructure:

1. Interoperability: In a 2018 HFMA survey, nearly three quarters (74%) of executives surveyed indicated that interoperability is critical for value-based care. Interoperability makes it possible for organizations to share data across systems. Without this, healthcare stakeholders have limited visibility into opportunities to improve clinical outcomes, as well as for cost savings. 

Interoperability is essential for better treatment of chronic conditions. Individuals with conditions like diabetes or heart disease often see multiple physicians and specialists. Effective coordination across these clinicians leads to more holistic care plans, but this is only possible if providers can easily share patient data. Chronic disease management may also require access to information about social determinants of health (SDoH) which can affect outcomes. Without interoperability, it becomes very challenging for payers and providers to get insights into SDoH. 

Care coordination is also valuable for people without chronic health conditions. The Cleveland Clinic explained in a Harvard Business Review article how it has enhanced care coordination so patients move more seamlessly through the healthcare system, reducing unneeded hospitalizations and visits to the Emergency Department. Achieving that level of coordination, however, requires integration across multiple platforms. 

Gainwell's Medicaid interoperability solutions empower patients to safely and securely access their medical data, while enabling states to future-proof their interoperability capabilities in accordance with evolving federal guidelines. Gainwell offers an Interoperability-as-a-Service solution, Patient Access and Interoperability, and a mobile digital platform. 

2. Managed Solutions: Value-based care demands speed and flexibility, whether that's for care management or managing claims. Legacy Medicaid Management Information Systems (MMISs), however, aren't well suited for that type of environment. Unfortunately, the journey to a modern Medicaid Enterprise System (MES) can be daunting. Gainwell's Medicaid Management Solutions offer states a streamlined, easy to deploy solution that meets CMS standards. The intelligent, automated cloud platform incorporates all the functionality needed to support value-based care. The solution can be implemented as a complete system or as individual modules. It can handle claims and encounters, care management, drug rebates, analytics, managed care, pharmacy, program integrity, providers, and third-party liability recovery. In addition, Gainwell's Medicaid Management Solutions are pre-integrated with Gainwell's analytics and interoperability services.

3. Analytics:  Analytics improve value-based care performance by providing organizations with insights into their operations, as well as into patient outcomes. This information helps identify ways to lower costs, while improving the quality of care. Access to data is a prerequisite for useful analytics, but this is often a challenge. A 2019 survey of health systems by KLAS found that data aggregation is a top priority in the shift to value-base care. Yet, technical barriers like poor data normalization and lack of data standards are problematic. Gainwell's next-generation enterprise data warehouse supports near real-time analytics and interoperability. It provides the adaptability that organizations need to support changing medical models, while applying artificial intelligence and machine learning to show program performance and uncover actionable insights.

In a world of value-based care, healthcare and information technology now go hand-in-hand. Navigating this environment can be challenging, but it doesn't have to be. Gainwell Technologies is helping many states to meet their Medicaid goals related to interoperability and more. To learn how we can help your state deliver the highest quality Medicaid services at the lowest cost, visit www.gainwelltechnologies.com.

Gainwell is the leading provider of technology, services and solutions that are vital to the administration and operations of health and human services programs. With 50+ years of proven experience, Gainwell has a reputation for service excellence and unparalleled industry expertise. We offer clients solutions for their most complex challenges.