U.S. Healthcare Payer CIOs Use Technology Innovations to Tackle Managed Medicaid Operating Model Changes

Published: 14 September 2018 ID: G00365730


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Managed Medicaid payers are under pressure from policymakers seeking lower program costs, higher-quality medical care and more beneficiary engagement. Managed Medicaid payer CIOs must fully leverage new technologies that support the emerging managed Medicaid operating model.

Table of Contents

  • Analysis
    • Increased Cost, Demographic and Political Pressures Force Managed Medicaid Payers to Reinvent Their Business Models
    • Managed Medicaid Care Management’s Focus Is Changing From Utilization Review to Population Health
    • Value-Based Contracts Shift Provider Payment Emphasis From Fee Schedule Reduction to Shared Financial Gains
    • Consumer Engagement Tools Allow Members to Move From Episodic Illness to Continuous Health Participation
    • Incentives Reinforce Member Behavior Change, Aiding the Move From Service Overuse to Personal Health Engagement
    • Heightened Regulatory Expectations Push Payers From Key Metric Reporting to Pre-Emptive Compliance
  • Gartner Recommended Reading
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