How Medicaid Payer Plans Can Hone Their Data Focus

Managing patients, providers, members, encounters, and other healthcare-related data domains presents a significant challenge for any healthcare organization.

Medicaid payer plans have a massive obligation to an already at-risk population. Medicaid covers one in five Americans accounts for one in five dollars spent on overall health care.  Medicaid payers simply can’t afford not to have their data in order. 

Data integration, interoperability through quality-of-care measurement, outcome tracking as well as data security and privacy are further complicated by the need for cost management and resource allocation. Regulatory compliance and reporting to federal and state authorities adds yet another layer for Medicaid health payer plan managers to navigate. Staying updated on changes for accurate and timely submission of precise data, collected from various sources and systems, is crucial.  

Solving this challenge requires involvement across people, processes, and technology. At the intersection of these three focus areas, specific attention needs to be given to your organizational data focus. Like the name suggests, a data-driven approach places data at the center of decision-making, planning, and operational processes. Deploying it effectively creates an environment where the organization’s central focus is on collecting, storing, analyzing, and leveraging data.

The Value of a Data Focus for Medicaid Payer Plans

While making data a central part of your organization is the ambition for every Medicaid payer plan, the practical reality is most struggle to effectively pull it off. The most common issue is defining the value of a data focus and aligning it with specific organizational objectives. 

Setting some foundational ground rules when embarking on this journey will clarify the objectives for becoming a data focused organization and the steps to get there. 

Key value adds from a data focus for Medicaid payer plan managers include: 

1. Operational Efficiency and Cost Savings 

With a data focus, Medicaid payer plans can streamline data operations, including data ingestion and data preparation processes, thereby reducing the burden and complexity of creating reports and insights. Additionally, a data focus will dramatically increase the accuracy and accelerate the speed at which statutory reports and extracts can be generated and shared with the relevant state or federal authorities, reducing the risk of penalties. 

For example, by using data analytics tools, a Medicaid health plan can quickly gather information from various sources to create a report on patient outcomes. Instead of spending days manually collecting and verifying data, the manager can now generate this report in just a few hours with accurate and reliable data. This not only saves time and reduces costs but also ensures that the report meets all regulatory requirements and is submitted on time, avoiding penalties. 

2. Enhanced Agility and Risk Management 

A key aspect of a data focus is storing and analyzing the data. Having managed and reliable data in a centralized storage mechanism, at your fingertips allows much more agility. This data asset provides organizational value through pre-built analysis models designed to combine data from different systems and address specific analysis and reporting needs. Another benefit is simply having the data in a single “queryable” environment to simplify and enhance ad hoc reporting. 

Pre-built, analysis ready models, where the data and processes for combining data have been validated and vetted, allows Medicaid health plan managers to reduce the inherent risk involved in manually creating regulatory reports. 

For example, instead of starting from nothing every time, Medicaid payer plans can rely on a centralized data system where all necessary information is already stored and easily accessible. This centralized system ensures that managers can quickly query the data, leading to more accurate and consistent reports, thereby minimizing the risk of inaccuracies, and ensuring compliance with reporting requirements. 

3. Enhanced Decision-Making and Planning 

Data-focused Medicaid payer plans leverage data to make objective, informed decisions, reducing reliance on assumptions or intuition alone. Decision making is enhanced by combining data with powerful decision support models, providing what-if analysis, and infusing it with AI. 

These models are highly valuable for cost and coverage planning. They use standard input parameters such as federal guidelines, state-specific adjustments, and organizational calculations to consider member needs, coverage impacts, and available benefits, creating an effective planning process.  

For example, a Medicaid payer plan might use predictive analytics to model chronic disease trends among different age segments of their membership. By analyzing data on chronic conditions such as diabetes, heart disease, and cancer within various age groups—like those aged 40-60, 60-80, and above 80—the manager can forecast healthcare needs and costs associated with these conditions. This model helps in planning for the allocation of resources, ensuring that costly and critical medical treatments are adequately provided for. Consequently, this proactive approach not only improves patient care but also reduces long-term healthcare costs by anticipating high-cost treatments and managing chronic diseases more effectively. 

How a Data Focus impacts People, Process & Technology

Though the value of a data focused organization is far reaching, the practical implications of building this must also be considered. As mentioned, data focus spans across the intersection of people, processes and technology and impacts each of these core aspects in a unique way, while creating a cohesive, data-driven culture that enhances decision-making and operational efficiency.

Here’s how to hone your focus in each category:

1. Upskilling Your People

Building a data-focused Medicaid payer plan encourages data literacy and a mindset shift across roles, empowering employees to make informed, data-driven decisions. Training and upskilling in data analytics become essential, fostering collaboration between business and technical teams.

2. Modernizing Your Technology

Embracing a data focus often requires investment in modern analytics tools, data platforms, and cloud infrastructure. Technologies such as data warehouses, data lakes, and machine learning models enable the collection, storage, and processing of vast datasets, making insights accessible across the organization. Effective use of technology also necessitates data governance frameworks, ensuring data quality, security, and compliance throughout the data lifecycle.

3. Refining Your Processes

A data focus enhances efficiency by refining existing processes and introducing data-based decision-making across workflows. Many processes in the organization will benefit from a data focus, allowing for accurate, timely and agile reporting and analysis. By aligning processes with a data focus, you can improve consistency and reduce manual interventions in the generation of analytics and reports.

Establishing an Analytics Harmonization Engine 

In part 2 of our Medicaid blog post series, we address how Medicaid payer plans can harmonize the data from various systems to meet all regulatory requirements. This is where an “analytic harmonization engine” is both powerful and effective. 

OmniData can support Medicaid payer plans beyond the core basics of improving people, processes and technology listed above.  

We’ll address the four areas where we can provide immediate results for Medicaid Payer plans with a Highly tuned Medicaid Analytics Harmonization Engine.

Read More: How Medicaid Payers Can Fuel An Analytics Harmonization Engine

About OmniData: 

At OmniData, we specialize in transforming organizations into data-driven powerhouses. Our expertise lies in creating agile, scalable data ecosystems that align with your business goals and challenges.  

With extensive experience in data strategy, analytics, and modern platforms like Microsoft Fabric, we help clients design and implement data-focused solutions tailored to their unique needs. From streamlining operational processes to ensuring compliance with stringent healthcare regulations, OmniData partners with organizations to deliver actionable insights and measurable results.  

Still not sure where to start? Consider our complimentary workshops as a next step towards honing your data focus and becoming a data-focused organization. 

Our "Analytics in Action" workshops provide a comprehensive 1-day deep dive into your current environments. By the end of the session, you will walk away with actionable insights that can immediately impact your operations and strategy. Discover the power of data with OmniData and take the first step towards unlocking your organization's full potential. If, however, you already have a strategy in mind and need a partner to help execute, our Data Team as A Service may be a better option. Schedule a consultation to determine your best path forward. 

Let us help you realize the full potential of your Medicaid data.