Medicaid Markets

Initium has extensive experience in Medicaid and has worked in states that both have and have not experienced Medicaid expansion as well as those experimenting with Medicaid ACO’s. Medicaid must be understood at the local level and the regulatory framework and financing mechanisms are in a great state of flux. Market segmentation and managing the growing Medicaid population has become central to the financial success of health systems. Increasingly systems look at the Medicaid population as an opportunity to develop the expertise at providing low-cost high quality primary and preventive care while leveraging technology. Caring for the Medicaid population requires distinct population health capabilities and states are increasingly incentivizing providers to invest in non-medical interventions. Core components of successful Medicaid strategies include information-sharing mechanisms, on-the-ground care coordination, provider community collaboration, robust quality accountability, and data sharing and integration. A cohesive Medicaid strategy must also include a robust plan of action for behavioral health.

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Integrated Strategy

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Strategy – Worked with an Integrated non-profit health system to develop a system-wide solution for managing Medicaid. Used health informatics model, public health data, and a heat map to develop care and operating models. The outcome was reduced no-show rates, increased revenue and improved health outcomes.

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Innovative use of CHW’s -Worked with a for-profit health system and created and implemented a program which used community health workers (CHW’s)  to enroll the uninsured in emergency rooms and conduct home and work visits with iPads to complete the applications. The result was over 1M in revenue for the system annually.