Medicaid is at a crossroads. All along the campaign trail President-elect Trump touted his intentions to repeal part or most of the Affordable Care Act. This could mean drastic changes. For starters, without even waiting for legislation, the Trump administration is almost certain to give states more freedom to run their Medicaid programs as they wish. One indicator of this is his nomination of Seema Verma to head the Centers for Medicare and Medicaid Services.
Verma comes to the job with extensive Medicaid experience. She worked closely with Vice-President elect Mike Pence (former governor of Indiana) to architect Indiana’s Medicaid expansion under the Affordable Care Act. The expansion plan, known as Healthy Indiana Plan 2.0, went into effect earlier in 2016. Healthy Indiana 2.0 was designed to improve care and reduce costs by a) encouraging personal responsibility on the part of Medicaid beneficiaries and b) requiring them to make monthly contributions to tax-free savings accounts earmarked for healthcare. In order to make this more affordable for the poor, the cost of preventative care and deductibles is not taken out of these accounts.
Verma has also worked with the states of Iowa, Ohio, and Kentucky to help design Medicaid expansion proposals. Some of the more conservative provisions require recipients to work or to be actively looking for work, and to pay for a portion of their care. So we know some big changes in Medicaid are probably in our future and Medicaid payers and providers will have to do more with less in order to achieve the triple aim of healthcare. So what won’t change?
We are all concerned that U.S. health care is too expensive, too inefficient, and too varied in regards to quality. Value-based care is an attempt to correct these issues. Payers are increasingly basing provider reimbursements on quality of care, not just on the number and type of procedures. Innovative organizations are focusing on process improvement to boost quality of care for patients, improve outcomes, and reduce costs. There may be some minor bumps in the road with upcoming changes, but considering this industry trend, we can say with confidence that value-based healthcare is here to stay.
Care Coordination is a key driver in value-based healthcare. Care coordination brings together primary care, behavioral health, and community-based providers in order to attain a holistic view of an individual’s needs. An integrated care coordination solution connects multiple providers and systems of care across a common platform and delivers custom patient care plans that are individually suited to the needs, circumstances, and abilities of each patient. All of these factors combine to help payers and providers achieve improved patient outcomes and reduced costs.
Patients have complex health needs and it is challenging to provide whole person care coordination when providers don’t have access to important patient data. According to HIMSS “Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.” In other words, interoperability allows the sharing of patient data from one provider to another without special effort on the part of staff.
The healthcare industry as a whole is moving towards achieving interoperability. Two pieces of recent legislation underscore this new focus: MACRA and 21st Century Cures Act, both of which will continue to drive interoperability and data sharing in the unfolding healthcare environment.
Change in the administration of healthcare is inevitable as we move forward. During this time of transition, however, the healthcare industry and states will continue their initiatives to achieve value-based care, whole person care coordination, and system interoperability. Data-driven processes and integrated health technology will play a leading role in making it all happen. With our care coordination and data analytics platform, Eccovia Solutions is leading the way for health and human service organizations.