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Managed Care Organizations Need Critical Data to Thrive

Public & Private Payers

Introduction

National health spending in the United States is projected to grow at an average rate of 5.5 percent per year from 2017 through 2026, reaching $5.7 trillion by 2026. While rising prices of medical goods and services and greater disposable personal income are partially to blame, increasing Medicaid costs are also a leading contributor.

As of July 2018, 34 states adopted a Medicaid Expansion program to bring new healthcare coverage options to low-income families. In response to this increase in Medicaid enrollment - and the correlated increase in costs that comes with it - states have continued to express interest in contracting with managed care organizations (MCOs) to help them deliver healthcare services to Medicaid beneficiaries.

Partnering with Providers on Clinical and Financial Health of Members

Arrangements between MCOs and states are increasingly risk-based, as MCOs control healthcare spending by trying to improve health plan performance, care quality, and overall outcomes. While the specific initiatives implemented by individual states under these contracts vary, the overall goals of MCOs are universal: Reduce unnecessary use of services and costs, focus on preventive care and early intervention, and provide quality care coordination and care management.

The push toward value-based care has amplified the need to achieve these goals, with MCOs looking to better understand the patient holistically: clinical, behavioral, social, and financial factors can all inform health and care. Traditionally, MCOs have worked solely with claims information, or the billable interactions between insured patients and a healthcare delivery system, to aid their strategies. Now, MCOs must expand their view, and overall understanding, of the patient by taking advantage of the clinical information residing in the patient health record.

Sumber Daya Terkait

01 November, 2024
BLOOR Research Opinion Article
This article from UK Analyst Bloor Research recognises the capabilities and advantages of InterSystems IRIS data platform as an "innovative and powerful data management platform" and it’s Smart Data Fabric capabilities offering a market differentiator.
31 October, 2024
A Benchmarking System to Spark Companies to Action
Download the Report
10 October, 2024
Get Your Data AI-Ready and Simplify Development and Deployment
Unleash the power of AI in healthcare with InterSystems solutions for seamless FHIR integration and development.
30 September, 2024
Video Overview
InterSystems OMOP is a cloud-based software-as-a-service designed to streamline healthcare research by automating the integration and transformation of clinical data into the OMOP format. This solution simplifies the creation of research data repositories and ensures easy data ingestion, transformation, and secure storage, accelerating the discovery of actionable insights and innovations in healthcare.
09 August, 2024
A CHIME Thought Leadership Roundtable
At a CHiME Roundtable, executives from leading HCOs came together to discuss how artificial intelligence revolutionize clinical care.
03 May, 2024
Digital Health Insights
Secure and clean FHIR data can help providers produce valuable insights to improve population health outcomes and personalized care.
06 April, 2024
A CHIME Thought Leadership Roundtable
At a CHiME Roundtable, executives from leading HCOs came together to discuss how they are addressing the shift to consumerism and creating digital experiences that meet – and exceed – rising expectations.
13 February, 2024
FHIR Use Cases
Practical applications for FHIR and real-world examples of how FHIR connects disparate systems, accelerates digital transformation, and increase data insights.
05 February, 2024
Marshfield Clinic Health System
Mitchell Kwiatkowski, Chief Data & Analytics Officer at Marshfield Clinic Health System, explains the company’s IT overhaul and how AI can be used ethically.
05 February, 2024
CHIME Digital Health Most Wired Survey
The Digital Health Most Wired Survey and Interoperability and Population Health In the tumultuous landscape within which healthcare operates, the annual CHIME Digital Health Most Wired (DHMW) survey is a significant “north star” that healthcare organizations (HCOs) have relied upon for years. Widely known for the annual Most Wired recognition awards, the DHMW survey provides healthcare leaders a comprehensive profile of digital health usage in U.S. HCOs and a reliable resource by which to benchmark their own digital health progression.

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