Looking to slash Medicaid costs? First, find the patients
'Hundreds of millions of dollars could be saved'
Integral to effective care coordination with Medicaid beneficiaries is the ability to communicate and reach those chronically ill patients. But it turns out the majority of Medicaid patients can't even be found by states and health plans. One new startup is working to change that.
On any given day, less than 40 percent of those on Medicaid – 72.6 million nationally, at last count – can be located by states and health plans. That's a pitiful percentage of a population that's often dealing with significant health issues, from multiple chronic conditions to lack of access to basic healthcare services, and whose typical experience with healthcare is a trip to the emergency room. And that's why Medicaid represents both a huge healthcare bill and a prime example of waste.
A Dallas-based startup is looking to improve that percentage by giving state officials and health plans a platform of web-based and mobile tools to find and engage those elusive Medicaid patients. The company, Health: ELT (it stands for Engagement, Logistics and Technology), says these tools serve a dual purpose: They allow healthcare providers to go out into the field with a smartphone, laptop or tablet and connect with patients, and they enable those same patients to locate needed resources and stay in touch with their providers via smartphone (one state estimates that more than 70 percent of its Medicaid patients have smartphones).
[See also: Data mining slashes Medicaid ER visits.]
Amanda Havard, Health: ELT's chief innovation officer, said each state and health plan has different procedures and policies for dealing with Medicaid patients, but most follow a similar routine for conducting home-based assessments. Or what are called LTSS reports. And right now, most of those reports are done on paper.
"Nobody in Medicaid is using (mHealth) tools in-house or out in the field … to find and continuously talk to these people," she told mHealth News. And from the patient's point of view, she said, "most of them have never been given a chance to deal with their health plans. They don't have continuity of care."
Havard said Health: ELT tested its digital platform in a six-month pilot project with a Texas managed care organization, targeting 1,000 so-called "unreachable high-utilizers," or Medicaid patients who are hard to locate except when they're in a hospital (which happens far too often). That pilot saw patient engagement rates jump from 37 percent to 73 percent, she said, while the number of ER visits per patient dropped from 7.14 to 3.45 per month.
Frank Siano, former chairman of Medicaid Health Plans of America, a principal at Acanthus Consultants and a member of Health: ELT's board of directors, said Medicaid patients often face "social barriers" to accessing healthcare, ranging from transportation to housing to employment. They fall between the cracks, and don't get the healthcare management they need to prevent minor issues from becoming full-blown trips to the hospital.
"It's not uncommon that 20 percent of a state's Medicaid population consumes 70 percent of the Medicaid funds," he said.
As a result, those entrusted with managing Medicaid plans are looking for better ways to connect these people with healthcare services – and ensuring they comply with doctor's orders after a visit.
[See also: EHRs help cut Medicaid costs, study says.]
"Hundreds of millions of dollars could be saved," he said, by connecting theses patients with healthcare resources. That might be as simple as an app that tells consumers what doctors nearby accept Medicaid patients, or a database that allows state Medicaid directors to update a patient's medical record rather than overwriting and creating a new record every time that patient visits a hospital.
That happens, Havard said, adding that, "I continually, day to day, learn things about Medicaid that have shocked me."
Havard said Health: ELT is working on an open platform that would enable each state to tailor its programs to the mobile tools. The company hasn't rolled anything out yet, but expects to do so soon.
"We're approaching this from a careful and customized way," she said. "And this is just the tip of the iceberg."
This story first appeared in Healthcare IT News' sister publication, mHealth News here.