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Research Gap in Medicaid

Abstract

The aging population will require more assistance with daily living and health care needs. Fortunately, a range of housing and care options is available. Over the past four decades the market for senior housing and care including assisted living and independent living communities has greatly expanded to accommodate people with more complex needs, and offer housing inclusive of personal care assistance services. Unfortunately, these settings are out of financial reach for the countries eight million middle income seniors (those seventy-five and older).

The private senior housing industry has generally focused on high – income earners. I project that by 2029 there will be 14.4 million middle – income seniors, 60 million of whom will have mobility limitations and 20 percent of whom will have high health care and functional needs. Many of these seniors will need senior housing care, I project that 54 percent of seniors will not have sufficient financial resources to pay for this type of care. The gap in senior - middle income struggle to afford long term care and housing needs demands attention both from policy makers and the private sector.

Introduction

This paper aims to identify the most pressing research needs of leaders in health policy and healthcare delivery systems. Furthermore, the report aims to focus on short- and long-term research needs of policymakers and leaders in health care delivery systems.

Impact on expansion vs. non expansion

Survey of literature[1] shows the need for evidence on the impact of expansion versus non expansion on enrollee health outcomes, providers, and state budgets. A wider emphasis should be paid on different approaches used by states to expand, Medicaid coverage. The traditional approaches follow federal rules established by Affordable Care Act (ACA). Alternative models use demonstration waivers from the federal government to expand Medicaid eligibility, while making broader changes to the way coverage is structured. Policymakers need information on individual health status and health seeking behavior especially for the newly eligible individuals seeking coverage under Medicaid expansion this information can help inform decisions about the benefit design.

Payment and Delivery System Reform

New and better research is required on payment strategies and delivery care models. There is a common need at the state level for better information on payments strategies, and care delivery models that incentivize quality improvement, control costs, and promote high value -care. States decisions about payment and delivery system reform happens in tandem with decisions about coverage expansions under ACA. We have to look at how we can expand access to care while coupling it with reform in the way we pay for care and the way it is organized and delivered.

Medicaid Managed Care

Medicaid managed care penetration varies across states, this is predominant approach for delivering services to the Medicaid population, half of the all the enrollees receive services in comprehensive risk-based plans. More emphasis should be paid to how states might make more strategic use of Medicaid managed care to drive cost and quality of goals, particularly among high cost and high need patient populations. Simultaneously, increased focus should be

[1] Brown, J.R. and Peter R. Orszag (2006), “The Political Economy of Government Issued Longevity Bonds”, Paper presented at the Second International Longevity Risk and Capital Market Solutions Conference, April.

Byrne, Alistair and Debbie Harrison (2005), Is longevity risk a one-way market? Report of the First International Conference on Longevity Risk and Capital Market Solutions, held on 18 February 2005, London.

Continuous Mortality Investigation, CMI, (2005a), “Projecting future mortality: Towards a proposal for a stochastic methodology”, Mortality Committee, Working Paper 15.

given to understanding how payments from a plan moves through a plan to a provider, and how that process affects endless access to care. Clear understanding of how the progression from Medicaid department moves right down to the person who actually cares for the patient. Further assessment is required to gain a thorough understanding of payment, and how that affects the Medicaid provider’s willingness and ability to add Medicaid patients to their practice.

Payment Delivery System

Payment delivery system[1] requires better value-based purchasing strategy. A good value-based purchasing strategy can help mitigate issues related to high cost, high need populations in terms of how they are being served, and how improvements in service can help answer questions related to patterns of care, and cost among this targeted populations. However, this type of strategy may face challenges related to measuring plans and quality performance.

Payment Reform

In depth survey analysis is required to gain a better understanding of how various states are balancing issues related to payment reform in terms of various plans. This type of analysis will help inform decisions related to gaining best value-based payment systems that both create incentives around appropriate cost containment and reward quality. Simultaneously, delay and help avoid some potential downside of issues related to sub- caption. For instance, a thorough understanding of Northern Virginia’s role vis-a’ vis the managed care plans requires good measurement indications for a good value judgment.

Focus on New Care Models – ACO

There is a continuing need for Accountable Care Organizations (ACO) ACO to see how they move patients to down-stream providers while maintaining overall accountability in terms of cost and care goals. A thorough comparison of state’s differing approaches is required to gain a better understanding of states programs of strengths and limitations.

Improved Data Quality and Timelines

Policy analyst need high quality, timely Medicaid data to conduct research to help inform policy decisions. Due to complexity of Medicaid data which requires significant resources, and expertise to conduct useful analyses in a timely manner as to gain better outcome associated with improved data quality, comparable data across states, and detailed Medicaid managed

[1] Brown, J.R. and Peter R. Orszag (2006), “The Political Economy of Government Issued Longevity Bonds”, Paper presented at the Second International Longevity Risk and Capital Market Solutions Conference, April.

Byrne, Alistair and Debbie Harrison (2005), Is longevity risk a one-way market? Report of the First International Conference on Longevity Risk and Capital Market Solutions, held on 18 February 2005, London.

care. Improvements in this area of process and methodology will result in better measures of access to care, quality of care and health outcomes.

Comparable data across states will gain insights on various aspects of Medicaid programs across states. Therefore, a need for uniform data collection and reporting practice is required across states to conduct efficient and effective comparative studies. Also consider experiences of other states to help inform policy decisions. State comparisons can help policymakers build the case for certain policy decisions, and often carry significant weight when compared to other forms of evidence.

Conclusion

In sum, new and better research is needed to help inform decision making on this issue. State comparison and experiences will help inform better decision making. Higher emphasis should be placed on comparison of expansion and non-expansion states, particularly the impact of expansion versus non expansion on enrollee health outcomes, providers and state budgets. Furthermore, more effective assessment is required to help integrate services and coordination of care among multiple systems to better serve Medicaid enrollees in area related to mental health, social services and criminal justice.


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