Innovation at work in Medicaid

As the nation’s largest health insurer, Medicaid offers investors and entrepreneurs the opportunity to deliver value and improve health
care on an unparalleled scale. Facing pressure to improve access, efficiency, and quality, the Medicaid market is primed for innovation.

Hover over the gears below to learn more about the market’s greatest areas of opportunity, and meet some start-ups already making an impact.

Medicaid

  • Medicaid finances almost 50% of all births in the US
  • 5% of those on Medicaid account for 50% of cost
  • 33 cents of every 
    dollar spent on
    physician services
    is paid for by
    Medicare/Medicaid
  • 44 cents of every dollar spent on hospitals is paid
    for by Medicare/
    Medicaid
  • Medicaid is the largest
    payer in the US for behavioral
    health services

Payments

Payments

Enabling payers and providers to be rewarded for delivering high-value care.

  • Tool to track value-based contracts using claims and electronic health record data
  • One-stop platform for managing value-based payment programs

Efficiency

Efficiency

Serving patients through streamlined approaches, saving time and money in a resource-constrained environment.

  • Telepharmacy and remote medication order processing services to hospitals
  • Software to streamline prescription refills
  • Electronic consultation platform connecting primary care providers with specialists
  • Outpatient cardiac monitor for low-cost, effective diagnosis
  • Improving workflow for community referral services

Care Delivery

Care Delivery

Delivering quality high-value care, particularly to those with complex conditions, who account for half of all Medicaid spending.

  • Round-the-clock home care, including behavioral and palliative care, for the patients with the most expensive and complex care needs
  • Team-based medication-assisted treatment delivery
  • Full-risk model for primary care for low-income seniors
  • Specialist consultation via telehealth

Prevention

Prevention

Delivering wellness strategies such as health education, managing patient needs, and predictive analytics.

  • Interactive tools that help curb the onset of Type 2 diabetes
  • Sensors, mobile apps, and services to better manage chronic respiratory disease
  • Connecting seniors to boost well-being
  • Digital nutrition platform
  • Technology-enabled personalized preventive health network

2017 California Health Care Foundation
www.chcf.org/medicaid-market

SOURCES: Anne Markus et al., “Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform,” Women’s Health Issues, Official Publication of the Jacobs Institute of Women’s Health (September - October 2013). Centers for Medicare & Medicaid Services (CMS), CMS Financial Report – Fiscal Year 2015 (PDF), November 9, 2015. Kaiser Family Foundation, Medicaid Financing: The Basics, December 22, 2106. Medicaid and CHIP Payment and Access Commission, Behavioral Health in the Medicaid Program ― People, Use, and Expenditures, June 2015.