Reforming Medicaid: Data needs to become accessible information

July 1, 2006

Widespread adoption of electronic medical record (EMR) systems in the future is a noble objective, however it has distracted policy makers from enabling true Health Information Technology (HIT) reform now. While others continue to champion EMR systems as former U.S. Department of Health and Human Services National HIT Coordinator David Brailer, MD, did, many in the health sphere confuse the advancement of EMRs with overall HIT reform. As industry pundits debate potential clinical benefits and cost reductions that EMR systems could deliver, there is too little discussion about how HIT can improve the single largest payer of medical claims-Medicaid.

Widespread adoption of electronic medical record (EMR) systems in the future is a noble objective, however it has distracted policy makers from enabling true Health Information Technology (HIT) reform now. While others continue to champion EMR systems as former U.S. Department of Health and Human Services National HIT Coordinator David Brailer, MD, did, many in the health sphere confuse the advancement of EMRs with overall HIT reform. As industry pundits debate potential clinical benefits and cost reductions that EMR systems could deliver, there is too little discussion about how HIT can improve the single largest payer of medical claims-Medicaid.

Medicaid continues to consume a growing percentage of states' overall budgets and costs are still rising. Why? Because the current Medicaid system is extremely large and the demand for Medicaid services continues to increase, yet this complex system is riddled with inefficiencies and fails to provide consistently high-quality healthcare. These inefficiencies are because of lack of coordination, medical errors, poor communication, incomplete records, rising insurance costs and myriad other factors. EMR systems alone will not solve these problems.

The federal government encourages Medicaid reform, but most states will rely on cost savings mandates such as increasing copays, extending nursing home look-backs and discounting drug reimbursements. What states need is a strategy to break down the silos of the fractured healthcare system. EMR systems and cost-cutting measures will help, but they are not the only vehicles for Medicaid policy reform. Real Medicaid policy reform will come by leveraging technology to unite Medicaid's redundant and disconnected factions.

With relatively minimal effort, administrative, claims, eligibility and other existing data can be used to make the patient the unit of analysis, rather than segmented programs. Medicaid EHRs can then be developed and, in near-real-time, create a dashboard giving providers, patients, and administrators a detailed look at the system. Can we manage the care of costly patients better? Are we providing the right preventive care? What is Medicaid spending the most money on? Who is it spending the most money on? How much money is wasted on duplication? How much money is wasted on non-optimal care settings? What would the impact be if existing care was simply managed better? This information must be shared among Medicaid agencies case mangers, providers and patients and organized in a meaningful, user-friendly manner.

By incorporating evidence-based decision support and predictive modeling technology, states can turn existing claims paying data into information that tells a story about a patient and gives providers a way to use it. But it is not good enough to keep this information within Medicaid. Patients, providers and medical institutions need access to this information so they can become part of the solution.

Imagine if states developed Web-based information portals where providers could easily determine who their sickest patients are, by name and disease, not just the total number of them? What if states enabled providers to use predictive modeling to help them understand who their sickest patients will be without intervention? With 25% of the Medicaid population consuming 70% of the budget, everyone involved could act more efficiently for top-to-bottom benefits.

EMRs alone will not solve the nation's Medicaid crisis. Medicaid must integrate its approach by leveraging technology to maximize existing data and to make informed decisions about policy, administration and patient care.

Bruce Greenstein is CNSI's vice president of healthcare.