With new demands forged by economic stimulus and health reform legislation, Medicaid is being defined by "a new paradigm" that will see it operate as a full partner in a national system of healthcare coverage, increasing the importance of the IT that supports it, according to Centers for Medicare & Medicaid Services officials.
The future Medicaid will no longer be just a safety net, said Penny Thompson, deputy director of the Center for Medicaid, CHIP, and Survey & Certification, who gave the keynote presentation Monday at the 2010 Medicaid Management Information Systems (MMIS) conference in Portland, OR.
It will be instead be an integral part of the three-legged stool that also includes employer-provided health coverage and the new state health exchanges that health reform law requires be created by 2014. And that will be an important consideration as federal and state governments develop a new system for eligibility and enrollment, she said.
"People may be eligible for Medicaid at one time, and for exchange coverage at another," she said. "So coverage needs to be continuous."
Over the next 10 years, government will become an even bigger purchaser of healthcare, she pointed out, so IT will be essential to understanding Medicaid's performance and what affects it, and for meeting coverage, quality and cost containment goals.
That means corralling many, disparate data points and combining administrative and clinical systems into a single, interoperable system. The ultimate goal is to improve service for both health care providers and beneficiaries, and make the system so responsive and friendly "it will be like doing business with Amazon."
However, getting there will be a challenge. The current state of information in the Medicaid program "is a tad inadequate," Thompson admitted.
That challenge was underlined by Bruce Goldberg, director of Oregon's Department of Human Services, who followed Thompson's speech. His state has so far been unable to deliver any kind of standardized health and Medicaid services to its citizens.
"It's all over the map," he said. "Cost and quality vary widely."
But he also pointed out that government will have dramatically increased leverage in the future, since governors and states will be the single largest purchasers of health care. The onus will be on them to make the health care delivery system work in the way that the states want it to.
The target for Oregon is to create an integrated system to manage the health of the people in the state, which will require a totally new health and human services information enterprise.
"Information and management solutions will be the key to this," he said. "Health information exchanges, new eligibility systems, financial management and forecasting, health analytics and more will be needed to move the needle on health outcomes in Oregon."
One initiative that will likely see a much greater interest and investment is the Medicaid Information Technology Architecture (MITA), a service oriented architecture (SOA) approach to Medicaid IT which is being proffered by CMS' Center for Medicaid and State Operations as a framework for improving systems development and health care management throughout the Medicaid enterprise.
The goals for MITA were written several years ago but are as relevant today, said Rick Friedman, the director of the CMS division of state systems. However, the program has gotten very little funding to date and has had to operate largely with volunteer help, though Friedman claimed it had nevertheless produced good results.
However, he said MITA is seeing increased support from the Obama administration and there is every possibility of increased funding for it in both the 2011 and 2012 federal budget proposals, which will allow more focused work on developing MITA as a catalyst for the kind of IT systems development that will be needed for the future Medicaid.
