Transforming the future of Medicaid

Transforming Medicaid programs and systems is by no means an easy endeavor. It is compounded almost daily by the constant change in social, technological, economic, and regulatory trends. In this issue brief, we explore the intersection of those trends with Medicaid, offering insights on how some of these trends are impacting programs today and projections for the future.

• The “always-on” culture - Technology has created our “always-on” culture and revolutionized how we manage our work and life, including in Medicaid where consumer demands are ever evolving. Some state Medicaid programs are using chatbots and modernized call centers to provide convenient assistance to beneficiaries.
• No longer taboo - mental health and substance abuse - Access to mental health and substance use disorder treatment remains a challenge, with only a small percentage of those in need receiving care. Medicaid programs are implementing changes such as covering opioid use treatment services delivered by telehealth and holding providers accountable for quality and timeliness of service to improve access to behavioral health services.
• Another social determinant of health – environmental impacts - Environmental impacts are emerging as another social determinant of health that disproportionately affects low-income populations and increases Medicaid costs. Some state Medicaid programs are addressing this issue by pursuing 1115 waivers to leverage funding for specific social determinants of health and coordinating with emergency management departments to address residents' needs.
• Applying artificial intelligence - Digital health and artificial intelligence are emerging as major disruptive technologies in Medicaid programs, with potential implications for operational efficiencies, policy-making, and beneficiary interactions. States will need to carefully understand AI’s impact on privacy and security, healthcare analytics, and direct patient care, and will need to involve all parties, including the state Medicaid agency, vendor partners, and beneficiaries, in its adoption.
• The future of Medicaid and its role in healthcare transformation - The future of Medicaid depends on optimizing consumer and provider behaviors through data-driven modeling and regulatory oversight and leveraging integrated care models to transform into a "care continuum" that focuses on population health. Some state Medicaid agencies are driving health care transformation through broader delivery system, program, and payment reform, and a person-centered approach to providing services and improving outcomes.

Let’s transform the future of Medicaid, together

At KPMG, we aim to think big while understanding that progress is often made in increments. Whether its reducing substance use disorders or preparing for environmental impacts, we are ready to help you achieve your future goals. Whether you are just beginning your transformation journey or adjusting course due to emerging trends, KPMG is here to help you think creatively, plan intentionally, and deliver successfully on your objectives. 

We offer a thorough portfolio of Transformation Advisory Services that help guide Medicaid system modernizations that meet your business and technical objectives, program and regulatory requirements, and quality and budget expectations. Let's transform the future of Medicaid, together.