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Improved communication, coordination, and collaboration among all members of the treatment team is the key to improving patient throughput, says Roxanne Tackett, RN, MBA, vice president of clinical services for Compirion Healthcare Solutions, a health care consulting firm with headquarters in Elk Grove, WI.
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As hospitals face cuts in reimbursement and patients who become insured under health care reform legislation seek care, moving patients safely and quickly through the continuum of care is going to become important, experts say.
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Beginning in 2014, individuals must be able to apply for and renew coverage for Medicaid, the Children's Health Insurance Program (CHIP), and tax credits for exchange coverage using a single application and to do this online. States will utilize existing state and federal government databases to establish, verify, and update eligibility
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States are facing a huge increase in Medicaid applications under the Patient Protection and Affordable Care Act, with the total number of recipients projected to grow more than 40%, according to the Congressional Budget Office.
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Ohio Medicaid is set to go live in December 2010 with a new claims adjudication system. This is expected to result in significant savings for the program, says Tracy Plouck, Ohio's Medicaid director. "We're going to have a front-end claims editor, which we see as a benefit relative to where we are today," says Ms. Plouck.
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To become eligible for Medicaid, an individual might have to visit a welfare office in the middle of the day several times, for a face-to-face interview, and struggle with confusing paperwork in order to prove his or her income. That scenario, however, may soon become a thing of the past.
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While research shows that Medicaid does a good job of facilitating access to care, compared to those without coverage, there are some concerns about access under the program. "This is especially true for specialty care," says Rachel L. Garfield, PhD, an assistant professor in the Department of Health Policy and Management at the University of Pittsburgh's Graduate School of Public Health.
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While many states are just beginning the process of evaluating ways to streamline the Medicaid eligibility process, Massachusetts did so a decade ago. That was when the state first looked into the possibility of developing an electronic application for Medicaid.
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The Medicaid expansion and the availability of premium credits for people with incomes up to 400% of the poverty line mean that millions of uninsured people will be able to get help paying for health coverage.
