6 Trends That Will Shape the Future of Medicaid Technology

November 10, 2022
Innovative IT Solutions , Healthcare

Medicaid technology is constantly evolving to support the delivery of improved patient care for eligible program recipients, optimize reimbursement for services delivered, document compliance with program rules and regulations, and measure the impact of programs on the health of patients. 

Here are 6 trends that will drive change in the Medicaid technology landscape:


  1. Ongoing Adoption of the modular Medicaid Enterprise Systems (MES). MES represent an update in Medicaid technology standards to addresses long-standing issues related to interoperability, adaptability, and data-sharing, including clinical data. With many legacy Medicaid Management Information Systems (MMIS) dating back to the 1980s, the reliance of legacy systems on outdated technologies, and the expanding number and complexity of Medicaid managed care programs, the potential for collapse of a state Medicaid program due to technology failure continues to grow. 


  1. Managed Care Oversight. Medicaid managed care programs are an efficient way to provide care to the growing population of people enrolled in the program. To be effective, and prevent abuse, these programs must be overseen by an agency with authority to support implementation of standards of care, ensure compliance to program rules and regulations, and collect quality measurements. As Medicaid managed care programs continue to grow in number and complexity, technology will need to evolve to accommodate the unique requirements of increasingly complex programs. 


  1. Adoption of Smart Devices. Smart devices are expected to eventually be in the hands of all Medicaid recipients. These devices give patients access to real time data about their health status and will empower them to play a more active role in managing their own health. Additionally, because a key aspects of the Medicaid program involves measurement of the quality and impact of service delivery on the health of patients, the data these devices provide will become an integral part of program evaluation and reimbursement.  


  1. A Shift Toward Wellness. With greater insight and data about the risk factors which lead to disease progression, Medicaid will shift focus and pay greater attention to prevention as opposed to treatment. To support this transition, Medicaid enterprise technology will need to undergo a large scale transformation from systems that manage and assess treatments and treatment outcomes, to systems that can manage a wide range of other programs types geared towards wellness and disease prevention. 


  1. Integrated Enrollment. There is broad support from states to pursue integrated enrollment initiatives for patients who are dually eligible for Medicaid and Medicare. This approach would support improving the quality of care delivered, and better ensure eligible individuals receive all of the support services they require. Although CMS is encouraging state-level initiative in this area, a longer term strategy is expect which will see support from more states, and an effort from CMS to eliminate conflicting requirements between the two programs. 


  1. Custom Healthcare. Custom treatments are a small but growing areas of healthcare from medical treatments through to behavioral treatments. The combination of behavioral data, AI and other technologies will pave the way for customized support programs with interventions tailored to the personality and health status of each patient. These programs will support patients to make positive changes in the behavior to achieve tangible health gains over time. Managment of these programs will, of course, require significant changes to Medicaid enterprise technologies to support their management and evaluation.