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State Health Analytics Services and Solutions
Leveraging the power of health data analytics
As Medicaid costs continue to rise, states are looking for innovative ways to use technology and health data analytics to manage costs, improve quality, and drive better health outcomes. At the same time, increased focus on value-based standards requires advanced analytics for Medicaid agencies to evaluate program results—from monitoring partnerships with managed care organizations (MCOs) and providers to identifying fraud, waste, and abuse.
- Analytics services and solutions
- Innovative operating models
- Leveraging predictive, behavioral, and cognitive analytics
- Actuarial analytics
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Innovative analytics services and solutions
Deloitte provides a range of analytics services and solutions to help states achieve their goals:
- Deloitte’s Medicaid Enterprise Solution (MES) HealthInteractive Analytics is a first-of-its-kind software-as-a-service (SaaS) solution providing state Medicaid agencies timely access to data from across the enterprise.
- The Analytics and Behavioral I
nsightsteam combinespredictive analytics and behavioral modeling to guide program design and execution strategies.
- Our health actuaries apply analytics to support strategy development and plan design, risk assessment, rate development, and reimbursement strategy.
How state Medicaid agencies establish innovative operating models
MES HealthInteractive Analytics enables data-driven decisions—helping state Medicaid agencies establish operating models that are innovative, business-driven, and outcomes-based. Deloitte’s MES HealthInteractive Analytics provides a robust end-to-end information architecture that offers state Medicaid agencies timely access to data from across the enterprise. It is a first-of-its-kind, software-as-a-service (SaaS) model deployed on a modern, secured, big-data public health platform. The solution aligns with Medicaid Information Technology Architecture (MITA) and delivers the full range of analytic capabilities in addition to delivering required federal reports such as Transformed Medicaid Statistical Information System (T-MSIS), Management and Administrative Reporting System (MARS), and Surveillance and Utilization Review Subsystem (SURS).
MES HealthInteractive Analytics goes beyond standard reports and static dashboards to give states insights into program effectiveness and support the development of new and innovative programs. Our solution helps agencies move from being reactive to predictive decision-makers. It provides analytics focused on achieving better health outcomes and supports information-based decision-making.
MES HealthInteractive Analytics tracks trends and performance across the organization to deliver better outcomes, including:
- Comparing the performance of programs, providers, and vendors
- Analyzing potential impacts of incentive programs and interventions
- Providing foresight through predictive analytics
- Determining issues related to service delivery and care coordination
- Identifying areas of concern related to health status, disease burden, and progression
- Uncovering potential sources of fraud, waste, and abuse
Our MES HealthInteractive Analytics solution aligns with CMS’ Seven Conditions and Standards and provides a robust and flexible service-oriented architecture (SOA) allowing Medicaid programs to interact, communicate, and share data securely.
Leveraging predictive, behavior, and cognitive analytics to improve state health and Medicaid programs
Deloitte’s Analytics and Behavioral Insights team combines predictive analytics and behavioral modeling to address the complex issues faced by state Medicaid agencies. Leveraging the power of machine learning, our team provides predictive algorithms, risk assessments, and treatment streams to help states reduce errors and work smarter.
The effectiveness of predictive analytics relies on the ability to accumulate strong data from multiple sources. Our team has worked with states to predict which customers will terminate from Medicaid or switch categories of assistance. Likewise, we use predictive analytics to identify business actions to reduce errors and protect eligible customers.
Predictive and behavioral analytics are used to:
- Reduce improper eligibility determinations and improper payments
- Nudge customer behavior through communication vehicles and encourage self-service for applications, change reporting, and renewals
- Identify recipients with a high propensity for eligibility issues
- Create tailored risk scoring of Medicaid applicants/recipients to prioritize and guide workload for state workers
- Target quality assurance samples based on high-risk areas
- Nudge members with high health risks to engage them in their care
- Tailor communications to influence customer behavior
Actuarial analytics across the spectrum to address state Medicaid concerns
Each state Medicaid program has its own set of challenges ranging in size and complexity, and leaders increasingly look to analytics to turn data into information and insights. The shift towards implementing new and innovative approaches to achieve cost-effective and high-quality medical care—such as value-based payment methodologies, quality incentives, and consumer engagement—requires detailed data mining and analytics to design an effective program.
Deloitte actuaries apply analytics to support strategy development and plan design, risk assessment, and rate development. We also help our clients improve the effectiveness of Medicaid reimbursement—guiding Medicaid agencies to make data-driven policy and program decisions with incentives for stakeholders to manage costs without sacrificing quality. We identify the financial impact of reimbursement reform and leverage quantitative skills, technical knowledge, and deep understanding of both public and private sector health care reimbursement.