*This article was originally published in MedCity News: Improve the Medicaid Provider Experience to Enhance Health Care – MedCity News
By: Jessica Stimpson and Gerald A. Maccioli
Every day, state Medicaid leaders grapple with the challenge of providing access to high-quality health care for a vast population while operating on limited budgets. Providers sit at the heart of this complex equation, yet becoming a Medicaid provider is fraught with complexities, hurdles, and inefficiencies.
Cumbersome paper enrollment processes. Long wait times. Lack of education resources.
Providers deserve better. They need streamlined enrollment processes that allow them to focus on what matters most—their patients.
Modernizing provider management processes, however, is no easy feat for already stretched Medicaid leaders. Many states turn to partners with operational expertise and technology capabilities for help. There are ways to solve the repeating challenges facing many Medicaid programs and providers. States can improve program efficiency, reduce administrative costs, and, most importantly, enhance the quality of health care for its members by acting in the following areas:
Streamline Administrative Processes
Switching to an online enrollment and credentialing process that’s managed by people who prioritize customer service will simplify the application process for providers. These platforms also allow states to integrate credentialing verification services, which will expedite provider onboarding without compromising accuracy. In addition, creating standardized forms that align with federal and state mandates and offering providers education resources will minimize confusion and errors. An area that is often overlooked is human oversight, which provides countless benefits when paired with technology, including ensuring compliance and ongoing process improvement. All this results in reducing administrative burdens for providers and the state.
Strengthen Performance Monitoring
Adding real-time data dashboards gives state agencies immediate insights into provider performance on key metrics like access to care, preventive care rates, and patient satisfaction. When states add advanced reporting tools to data analytic tools, they can analyze trends, identify outliers, and generate actionable insights for interventions that target specific areas of improvement within the provider network. This results in quality metrics aligned with national standards while addressing program-specific goals.
Support Quality Improvement Initiatives
Incorporating quality educational resources and training programs will equip providers with best practices, quality improvement methodologies, and coding compliance knowledge so they can do their jobs better. In addition, technology solutions support data-driven quality improvement initiatives. Both areas allow for continuous monitoring and improvement within the provider network.
Enhance Network Adequacy
To gain insights into gaps for network improvement, data analytics tools need to be incorporated into the provider journey. This will help identify areas experiencing staffing shortages and help state agencies develop targeted recruitment campaigns to attract and retain qualified providers in underserved regions. From financial incentives to loan forgiveness programs, states will be well-positioned to improve their networks based on real-time data.
Medicaid provider management is constantly evolving. State Medicaid programs must embrace innovation and collaboration to ensure continued program success. By acting on the items shared above and working with qualified partners, state agencies can gain access to the expertise and resources necessary to streamline administration, enhance network adequacy, strengthen performance monitoring, and support provider-driven quality improvement initiatives. This collaborative approach fosters a more efficient and effective system, ultimately improving health outcomes for the millions of Americans who rely on Medicaid.
About the authors:
Jessica Stimpson is the public sector market lead at Noridian Healthcare Solutions. Serving as the central contact for state health programs, Stimpson brings the innovative administrative services and renowned customer experience Noridian is known for to new Medicaid markets. As market lead, she manages relationships with key Noridian customers and influencers, including executive leadership, external stakeholders, and operating leaders. Prior to this role, Stimpson worked closely with Noridian for nearly two decades in a customer capacity, most recently as the vice president of sales and marketing at Blue Cross Blue Shield of North Dakota.
Gerald A. Maccioli is a critical care anesthesiologist with 36 years of clinical practice and senior leadership roles in various medical organizations. He has a fellowship from Duke University, a residency from UNC Chapel Hill, an MBA from Auburn University, and over 50 publications on diverse topics in his field. He is currently the Chief Medical Officer for HHS Technology Group, after serving as the Chief Quality Officer for Envision Healthcare.