The Bigger Picture: Fixing Medicaid
Is it about clinical or administrative waste?
By Pamela Moore Recently the inspector general of the federal agency that oversees Medicaid issued a report praising 12 states for their model use of technology. The states are using claims-based electronic health records, e-prescribing, and remote disease monitoring, among other tools.
I compared this list of states with the top-performing Medicaid agencies in PayerView, our ranking of payers based on how easy they are to work with. I expected congruence. Technology, one assumes, contributes to efficiency. But there was almost no overlap.
Why not? The Department of Health and Human Services [DHHS] is looking at clinical waste, an obvious concern for near-broke Medicaid systems. The government wants technology that saves money.
On the other hand, PayerView implicitly encourages technologies that get physicians paid more easily. It discourages the kind of administrative waste that leads to payment hassles. From a PayerView perspective, the core issue for Medicaid is whether a program insists (as so many do) on outdated, onerous payment bureaucracies.
For example, PayerView scolds New York Medicaid for taking 180 days to pay the average claim. With PayerView, the idea is that cutting out the nonsense makes it easier for physicians. It means there is more money spent on beneficiaries instead of administration and that there will still be physicians willing to see Medicaid patients. Continued...
