Posted by ProgenyHealth on Mar 3, 2021 8:17:51 PM
Like a perfect storm brewing on the horizon, new studies expect
state budgets to be hammered by growing Medicaid enrollment, rising health
inequities, and unmanaged Social Determinants of Health.
Surge in Enrollment
COVID-19 layoffs triggered a surge in enrollment, but as the
pandemic continues to unfold, Medicaid dependency will grow as well. Medicaid
policy changes will also play a role by limiting the tools available to states
to manage the crisis.
Since 2000, Medicaid spending has more than tripled, surpassing
$613 billion in 2019 when 75 million people were on Medicaid. For every three
dollars states spend, one goes to Medicaid.
The Foundation for Government Accountability study sees the
pandemic surging an enrollment increase of 55 million – a 73 percent increase
nationwide. ACA expansion states will be hit the hardest.[1]
Also fueling the growth, another study found that 47% of
uninsured Americans during the pandemic did not consider Medicaid or ACA plans,
assuming they were ineligible. With the new administration, policies may be
enacted to improve awareness and accessibility of Marketplace and Medicaid/CHIP
coverage – policies that will also fuel the enrollment surge.[2]
The Takeaway –
State Medicaid directors will need to take decisive action by implementing
savings levers that mitigate increased Medicaid enrollments.
Rising Health Inequities
According to the March of Dimes, women of color and their babies
consistently have worse health outcomes than white mothers.[3] Among
their findings:
·
Bias
in Care – The attitudes
and behaviors of health care providers have been identified as a factor in
these inequities – often enacted without conscious volition.
·
Healthcare
deserts – Each year in
the U.S., approximately 150,000 babies are born to moms living in maternity
care deserts or communities without a hospital offering obstetric care and
without obstetric providers. Women in these communities have difficulty
obtaining appropriate and quality care before, during, and after pregnancy.
·
Unequal
Access – 16 percent of
childbearing age women are uninsured compared to 9 percent in states with
expanded Medicaid.
The Takeaway - Health inequities will further strain the system. Health
organizations don’t wield government power, yet they will recognize the
significant role they must play in achieving health equity and addressing
disparities at the point of care.
Download the Perfect Storm Infographic
Unmanaged Social Determinants of Health
Among the Medicaid population, the social determinants of health
challenge women managing a pregnancy or caring for a newborn. For example, the
cost of healthy food might be too high or inaccessible. Transportation and
childcare issues also make prenatal appointments a challenge. Other social
determinants include economic stability, education and literacy, neighborhood
safety, provider availability, and more.
As a result, the impact of SDoH is significant:[4]
·
Health Literacy
affects 90 million Americans.
·
1 in 8 Emergency
Department visits are related to substance abuse and mental health.
·
Adequate housing
reduces Medicaid claims by 55% and ED visits by 24%.
·
1 in 8 face Food
Insecurity
The Perfect Storm is Coming – In 2021, Medicaid programs will need to
leverage specialized partners to prepare for the Perfect Storm. For example,
with the surge in enrollment, ProgenyHealth can reduce rising Medicaid NICU
costs to deliver an average 2-1 ROI using industry-leading UM and CM
processes, technology, and expertise to improve outcomes and lower NICU costs.
In the face of growing health inequities, keeping focus on the
right level of care and support is critical for the infant. As critical is
helping to ensure that the mother has a full understanding of the plan of care
and resources available to her and her family as she navigates her baby’s first
year of life. ProgenyHealth’s team helps to ensure this happens.
And in the face of SDoH challenges, we provide the
infrastructure needed to integrate NICU-specific SDoH case management into the
broader clinical ecosystem through seamless coordination between clinicians and
social service professionals.
1 https://thefga.org/research/covid-19-medicaid/
2 https://healthpayerintelligence.com/news/47-of-uninsured-americans-did-not-explore-aca-medicaid-options
3 https://www.marchofdimes.org/mission/reportcard.aspx
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