Healthcare Vision Blog

  • Growing your share of the Managed Medicaid market: what will it take to succeed?

    "Government Programs represent a large growth opportunity for our clients. Our solutions help increase operational efficiency around claims and data submissions to improve productivity, facilitate enrollment administration and financial reconciliation."

    By: Becky Erbe | Dec 02, 2015

    Healthcare reform has offered incredible opportunities for anyone operating a health plan today. But taking advantage of this evolving landscape may require some pretty significant changes to the way you do business – especially when it comes to managed Medicaid.


    Managed Medicaid

    Managed Medicaid is one of the biggest opportunities for revenue growth over the next few years. Nearly 93 million individuals will be eligible for Medicaid by 2024, and the vast majority is projected to enter managed care plans . Whether you’re currently in this market or planning to expand into it, your success will depend on your ability to adapt in some key areas: specifically, how you efficiently manage enrollment, handle claims processing, coordinate care and control costs for this vulnerable population.


    What it will take 

    Taking advantage of the new realities of the Managed Medicaid market will require IT investment in scalable, flexible enterprise systems that let you quickly respond to changing needs. With the right systems, you’ll have the agility to make great strides in a wide variety of new opportunities related to the Medicaid market.


    Priority #1 will be core administration, network management and care management systems that are tightly integrated and enable a great deal of automation in enrollment, eligibility, renewal, and in billing/collection. 


    Robust analytics will be critical, too. With the right tools, you’ll be able to better segment and target those populations that may need more intense care coordination, and you can compare the value and costs of clinical and incentive-based programs. With the use of analytics you can be more proactive in managing the care of your Medicaid members.


    And technology that supports incentive programs such as value-based insurance design will be a game changer. By incentivizing members to manage their own care more effectively through personalized wellness, support and educational programs, you’ll not only improve the health of your member base but reduce and control your costs.


    While you’re working hard to develop your strategy for managing growth in the age of healthcare reform, we at TriZetto are working to provide the kind of flexible solutions that will let you adapt to this dynamic and competitive market. 

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    Written by: Becky Erbe
    Vice President, Government Programs


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