Gartner Research

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

Published: 14 September 2018

ID: G00365730

Analyst(s): Bryan Cole


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


  • 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

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