November 2, 2012 By Justine Brown
One day soon, patients will routinely interact with doctors via remote telepresence. It’ll be common for people to take digital photographs of medical conditions and send them to health-care professionals for evaluation. And improvements in data capture and analysis will lead the way toward better, more cost-effective medical care.
In 2009, Medicaid costs accounted for an average of 15.7 percent of states’ general fund spending, according to Medicaid and State Budgets: Looking at the Facts, a publication of the Center for Children and Families. By 2011, that amount had risen to 16.8 percent, with no sign of slowing in sight. Medicaid as it exists today is simply not sustainable. A new model that meets the needs of an aging population is necessary. The Affordable Care Act (ACA) requires states to take a number of steps over the next several years to reform the system. And while the ACA’s future also is in question (Gov. Mitt Romney has promised to repeal all or part of it if he’s elected president), the need for significant reform still is evident, and technology will likely play a role in a number of areas, including enrollment and eligibility, pay-for-performance and electronic medical records.
Cheryl Camillo is a senior researcher with Mathematica Policy Research, a Princeton, N.J.-based research organization. Camillo focuses on ACA and Medicaid and is also the former executive director of the Maryland Office of Eligibility Services. Camillo said the ACA is motivating states to use technology to change the future of Medicaid application and enrollment processes.
“From 2014 through 2019 there will be a substantial transformation of Medicaid due to ACA,” said Camillo. “If it all works out, the Medicaid program in 2020 will be very different than it is today, especially in the eligibility and enrollment areas. The use of IT systems will be a significant part of that.”
Rather than apply to numerous programs to determine eligibility, future applicants would fill out one electronic application and be automatically routed to the most appropriate program with minimal interaction and paperwork — a scenario dramatically different than today’s complex, paper-driven process.
“Information technology is essential to making that happen,” Camillo said. “It will allow people to apply electronically, and the systems will interface behind the scenes. The data needed to determine eligibility would be pulled from sources where it already exists electronically.”
Technology could also play a significant role in changing how providers interact with and manage chronic care patients. According to Alain Enthoven, professor of public and private management at Stanford University and a founder of the Jackson Hole Group, a national think-tank on health-care policy, Medicaid’s open-ended, fee-for-service payment system is a major contributor to the high level and rapid growth of spending. In 2009, the Massachusetts Special Commission on the Health Care Payment System said that fee for service “rewards overuse of services, does not encourage consideration of resource use, and thus cannot build in limitations on cost growth.”
Moving to a fee-for-performance scenario would change how doctors are rewarded while also promoting better outcomes. “Medicaid as we know it is a 1950s-era concept based on acute, episodic care and built around a doctor making a living,” Enthoven said. “In the future it will be more about doctor performance, actually helping improve health, and reducing patient dependence on the doctor. Coaching and electronic exchange of information would replace many in-person visits, and patients would be encouraged to manage their own health.”
Aneesh Chopra, senior adviser of health-care technology strategy at the Advisory Board Co., envisions a similar scenario. “Once a doctor has all the data they need, they could begin to look at how to best engage the patient in newer ways to improve their overall health outcomes. Technology tools could be used to collect patient monitoring data, and doctors could text or call patients instead of having them travel to the office,” Chopra said. “I envision an iPhone App Store scenario where patients download and use tech tools that support behavior change and help them make better health decisions.”
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