Medicaid Medical Management: A Potential Savings for States Facing a Budget Crunch
Programs offer state governments potential cost savings and better-quality services
Medicaid is facing difficult times. Enrollments are climbing, costs are soaring, enrollee health problems are more complex and providers who will agree to treat them are rapidly disappearing.
Today Medicaid is a $340 billion program that covers 62 million Americans and, at 22 percent, is the single largest expense category in state fiscal budgets
If left unchecked, rising Medicaid costs will likely divert investments in education, general services, infrastructure and employee compensation. But what can policymakers and other stakeholders do to prevent the single-largest expense category on their state fiscal budget from getting even larger?
"Medicaid Medical Management: A Complex Challenge for States," a study by the Deloitte Center for Health Solutions, part of Deloitte LLP, provides a strategic view of one critical aspect of Medicaid oversight that offers savings potential while also improving the quality of health services provided to enrollees – medical management programs.
This report explores several ways in which states can use Medicaid medical management to control their Medicaid costs. Leading practices encompass two main categories: Clinical Population Care Management and Administrative Medical Management. Overall, successful state Medicaid medical management programs leverage information systems to:
- Identify and stratify patient health risks for population segmentation
- Engage and enroll patients and providers in appropriate care programs
- Incentivize and promote accountability
- Measure results