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The Potential of a Population Health Strategy to Improve Healthcare Outcomes and Reduce Costs for Medicaid Programs

David J. Dzielak, PhD
With Medicaid consuming a larger share of the Mississippi's budget, innovative solutions were needed to deliver improved health outcomes at a lower cost. A public-private partnership was created to pursued a population health strategy aimed at reducing preterm births and preventing the progression of prediabetes to type 2 diabetes.
There is a heightened interest in the healthcare outcomes of managed care programs from the federal regulatory body, the Center of Medicaid and CHIP Services (CMCS), that oversees the Medicaid managed care programs. The recently promulgated Medicaid Managed Care Final Rule12 puts a great deal more emphasis on state oversight and health outcomes. These new rules indicate that the federal government is now interested in the cost-to-benefit ratio and whether managed care can improve health outcomes and lower costs as a result. As the cost of healthcare and the cost of the Medicaid program at both the state and federal levels increase, there is likely to be further emphasis on cost containment as a product of improved health outcomes. Population health platforms offer a new tool that can be applied to achieve these results.

Of anecdotal interest is the fact that CMCS was very receptive to the concept of a population health approach to improving quality and outcomes in the Medicaid program. When the Mississippi Division of Medicaid submitted its Implementation Advanced Planning Document for enhanced funding for its population health initiative, it was received with great interest and approved within a 4-week time period, a short turnaround for proposals of this type.

In 2017, the Mississippi Division of Medicaid completed a reprocurement of its managed care program, adding contract language that requires managed care plans to implement a population health-based strategy as part of its ongoing operations. While debate continues over who should deliver managed care to the state’s Medicaid recipients, the future seems to point toward a population health approach.

While the program is still in its infancy, there is significant potential for population health platforms to improve healthcare outcomes, which can not only lead to healthier, more productive individuals but also substantially lower the cost of healthcare in Medicaid programs. 

Financial Disclosure

There are no conflicts to disclose.

About the Author

David J. Dzielak, PhD, served as executive director of the Mississippi Division of Medicaid from January 2012 to December 2017. He is an integrative cardiovascular physiologist whose research has focused on the neural control of the circulation and the role of immune mechanisms in cardiovascular disease. He received his PhD from the University
of Mississippi Medical Center (UMMC) in 1982 and returned to the medical school in 1987 after working in the private sector. At the time of his appointment as Medicaid director, he was UMMC’s associate vice chancellor for Strategic Research Alliances; he helped the medical center secure more than $74 million in congressional funding and played a major role in promoting technology transfer and biotechnology development with academic and business partners.
References
 
1. Rudowitz R, Gifford K; Henry J. Kaiser Family Foundation. Medicaid moving ahead in uncertain times: findings from the annual Kaiser 50-state Medicaid budget survey. kaiserfamilyfoundation.files.wordpress.com/2017/10/medicaid-budget-event-slides-10-19-17.pdf. Published October 19, 2017. Accessed February 2, 2018.

2. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. doi: 10.1377/hlthaff.27.3.759.

3. Kindig D, Stoddart G. What is population health? Am J Public Health. 2003;93(3):380-383.

4. Medicaid in Mississippi. Henry J. Kaiser Family Foundation website. files.kff.org/attachment/fact-sheet-medicaid-state-MS?utm_campaign=Revue%20newsletter&utm_medium=Newsletter&utm_source=MHA%20Revue. Published June 2017. Accessed February 2, 2018.

5. Percent of children covered by Medicaid/CHIP by congressional district,2015. Georgetown Health Policy Institute website. ccf.georgetown.edu/map/2015-children-congressional/. Accessed February 5, 2018.

6. County data: diabetes, obesity, and leisure-time physical activity. Centers for Disease Control and Prevention website. cdc.gov/diabetes/data/countydata/statecountyindicators.html. Updated May 16, 2016. Accessed February 5, 2018.

7. Martin JA, Hamilton BE, Osterman MJK; National Center for Health Statistics.Births in the United States, 2016. www.cdc.gov/nchs/products/databriefs/db287.htm. Updated September 26, 2017. February 5, 2018.

8. 2017 premature birth report card. March of Dimes website. marchofdimes.org/mission/prematurity-reportcard.aspx. Published October 2017. Accessed February 5, 2018.

9. Data on file.

10. Preterm birth. Centers for Disease Control and Prevention website. cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm. Updated November 27, 2017. Accessed February 5, 2018.

11. Delta Health Alliance website. deltahealthalliance.org/project/medicaid-health-demonstration-project/. Accessed February 5, 2018.

12. Centers for Medicare & Medicaid Services. Medicaid and CHIP managed care final rule. medicaid.gov/medicaid/managed-care/guidance/final-rule/index.html. Updated December 2016. Accessed February 2, 2016.
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