Medicaid data is the ship that gets us to health care’s new world

For more than 50 years, Medicaid has been there to provide needed health-care services for the disabled, mothers and children in poverty, the aged poor, and now as a result of the Affordable Care Act, those that are working on the lowest rung of our economy. Given its size, the data generated by Medicaid should be radically transforming the health system. It isn’t.

How big is Medicaid? It pays for 62 percent of nursing home residents.  It covers nearly half the births and 40 percent of the children in the United States. It’s responsible for nearly 70 percent of the disabled.  It is the largest payer for behavioral health and addiction services. Today it covers one in five Americans.

{mosads}Medicaid is a federal and state partnership. As a result, there are 57 distinct programs administered by each state, U.S. territory, and the District of Columbia. Every program manages data given to them by health plans, hospitals, doctors, nursing homes and other providers slightly differently because each Medicaid program is tailored to the needs of those covered.

This design means that it is very hard to get timely, reliable Medicaid data. Medicaid’s vast array of services provided and wide variety of populations covered means that it is impractical for the federal government to be the central actor that “owns” the data. The states, the other half of the partnership, are increasingly under financial pressure, so investing in the information technology needed to use and analyze the data is more and more challenging.

The good news is that the Medicaid program is transitioning from a fragmented, poorly run fee-for-service system to a fully integrated, managed model where health plans take full financial risk for providing high quality care for our nation’s most disadvantaged. Nearly three quarters of all Medicaid enrollees are served by Medicaid managed care organizations.

That coverage comes with extensive data collection and analysis as plans create individual care management structures designed to provide better care at lower cost. The challenge for plans is that they are often asked for data in a duplicative fashion, with different requirements and mandates by the state and federal governments, and no standard for data protection.

How do we get this high quality, well-analyzed health plan data into an environment where federal and state taxpayers, who are responsible for the funding of this program, can make decisions about what works and what doesn’t? More important, how can the terabytes of data housed by the plans be used to drive better health outcomes for those that rely on Medicaid?

To do this, the Medicaid directors, along with the Center for Medicare and Medicaid Services (CMS) and the health plans that are the coordinators of services for enrollees, should come together to productively think through a standardized platform that can be used to make “big data” inform big decisions. We know that unfunded federal mandates to the states don’t work, and that states working independently cannot get us to this far shore.

Leveraging the knowledge of health plans can set us sailing toward the New World where quality Medicaid data bring to life increased health outcomes. Rather than one more required data set creation, now is the time to rethink what already exists with an eye towards wringing inefficiency out of our current data collection efforts and to leverage the power of the health plans.

Jeff M. Myers is the president and CEO of Medicaid Health Plans of America, the national trade association representing the Medicaid managed care industry.