Population health management and Medicaid transformation

Health and Human Services (HHS) programs are increasingly looking to implement coordinated strategies to improve the health and wellbeing of their beneficiaries, promote equity, and support sustainable cost growth across the health, behavioral, and social care continuums. Over the past years, several state Medicaid agencies (SMAs) have focused on improving population health and quality of outcomes through approaches that address whole-person care needs. This includes making investments to improve coordination, engagement, and the infrastructure needed to shift from reactive episodic care to proactive holistic care coordination and tailored service delivery.

Parallel to the development of population health strategies, many states have also been working on Medicaid Enterprise Solution (MES) modernization efforts. As states seek programmatic flexibility and funding maximization support from the Centers for Medicaid and Medicare Services (CMS) for enterprise transformation initiatives, there is an opportunity to include population health management strategies into the comprehensive enterprise transformation approaches. By integrating population health management transformation with MES efforts, enterprise investments may be maximized while providing a blueprint for population health strategies that can be further expanded to additional payers, programs and populations.

This issue brief examines considerations and practical approaches to improving cross-continuum coordination by harnessing advancements in technology, data and analytic capabilities, improved processes, and person-centric adaptations for population health management and health equity.