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Using IT to meet the challenges of Medicaid services

March 5, 2019

medicaidApproximately 19 percent of the U.S. population is covered by Medicaid, or roughly 70 million people.  Among the rural poor, especially, with children and elderly are at risk in underserved and lower socioeconomic regions of the country.

Challenges in caring for economically disadvantaged communities  

Many of these communities lack sufficient food to stay healthy, as well as access to childcare and reliable transportation to appointments. Housing may be an issue as well, especially if patients reside in domestic violence or other shelters, making traditional methods of collecting reliable user data next to impossible.

Challenges for Medicaid in adopting newer technologies:

The cumbersome, older legacy Medicaid management information systems (MMIS) found in platforms still used by most state Medicaid programs are hard-coded as well as large. Consequently, making even minor changes or updates is time-consuming and expensive and as they often involves complete system overhauls, necessary upgrades and other changes go undone. Some of the issues arising from using outdated platforms and older technologies include:

  • Fragmented EHR data among various providers
  • Identifying other related care gaps: transportation, child care, multiple case workers, etc.
  • The need for more robust screening, especially among pediatric patients
  • A critical need to untangle patient attribution and other identification problems

The Centers for Medicare and Medicaid Services (CMS) as well as states have recently begun taking steps to change with the times and are requesting interoperable modules to replace the monolithic solutions of the past as well as moving some platforms to the “cloud.” This has opened the door for technology vendors to be part of the solutions with more flexibility and innovation.

Cloud-based computing

As Medicaid organizations upgrade platforms, many are moving directly to cloud-based solutions, including machine-based learning (see below) from cloud providers such Microsoft, Google and IBM. This allows the access to machine-learning applications to utilize “chatbots’ to improve customer relations or as well identify other patterns in patient data that better-inform about patient care.

Machine learning

Simply put, it is a computer’s ability to automatically apply algorithms to sets of big data to gain insights for decision-making. Deep learning, for example, closely imitates the human brain’s workings in data processing and creating patterns used in making better decisions that can improve patient care.

How the Internet of Things (IoT) helps with Medicaid

The Internet of Things refers to the interconnectivity of computing devices through the Internet and embedded into everyday objects, allowing them to receive and transmit data. Some benefits of IoT include enhanced abilities for Medicaid to:

Promote independent living

With the move by Medicaid from institutionalized care to more home and community-based services (HCBS), IoT can enhance independent living through remote patient monitoring and non-emergency medical transportation as well as target those patients in need of medical interventions.

Identify and target necessary interventions

Machine learning and GIS can assist administrators in identifying at-risk patients for adverse an expensive health situations and outcomes through their abilities to draw on multiple sets of data in real time, and develop personalized interventions.

Improved delivery of non-emergency Medical transportation services (NEMT)

As a required Medicaid benefit, NEMT was intended for those who have no other means of transportation for doctor visits and other medical services. Because of scheduling criteria requiring rides booked at least 24 hours in advance, same-day appointments or other situations may be problematic, resulting in missed appointments which can have adverse health effects as well as raise costs. 

Some organizations and MCOs have recently partnered with ride-share companies and their apps (API), such as Uber, to provide on-demand service, with billing and other accounting activities handled at the system’s back end. On-time rates have jumped to 95 percent, with savings of up to 70 percent per ride compared to traditional modes of NEMT.

Remote patient monitoring (RPM)

Hospitals in many areas already use devices that measure blood pressure, glucose and weight, which are reviewed by a healthcare provider. Using IoT technology, such as motion sensors and other devices, providers and others can now more closely monitor patients’ movements and other patterns to better respond to their needs. include determining whether they have fallen or have taken their medicine in the correct doses through the collection and storage of sensor readings into a database where they can be analyzed and appropriate action taken.

Several innovative partnerships between healthcare organizations, technology vendors and other partners:

Healthify – Launched in 2013, this company works with Medicare and Medicaid patients in 30 states using technology to identify socioeconomic factors impacting health and connects patients with necessities such as food and shelter.

Bright Health – The organization works to coordinate care of elderly frail patients, with the development of technology-assisted value-based models such as Programs of All-inclusive Care for the Elderly (PACE) and offers care for patients aged 55 and over who are deemed eligible for nursing home care by their state’s Medicaid agency.

Circulation – This startup cooperates with hospitals and other health organizations to provide non-emergency transportation on demand.

While improved technologies alone won’t solve many of the problems faced by a program as large and complex as Medicaid, they can make it more efficient in providing necessary patient services, predicting and improving outcomes while saving money. As long as they are cohesively integrated into the larger framework, they can solve many of the current challenges that have impeded Medicaid from doing its intended job.

How working with a billing and practice management service complements IT for Medicaid providers

Founded in 2002, M-Scribe is a billing service leader, offering comprehensive medical practice services for practices of all sizes and specialties. Contact them at 888-727-4234 or by email for a free analysis of your practice’s needs and revenue goals.


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