Healthcare reimbursement models are changing for Medicare, Medicaid and other public programs. Data analytics is at the heart of policy and reimbursement models evaluation. Over the past two years, our team has participated in the development of a knowledge discovery infrastructure being used by the Centers for Medicare & Medicaid Services (CMS), and we have been part of the effort to bring Medicare and states’ individual Medicaid systems together for the first time. This unification of data systems is important for looking at Medicare and Medicaid over payments for beneficiaries making claims under both systems and as an important step in pulling together all the data to address fraud, waste and abuse.
Data analytics and simulation will also be a key element of successful proposals and program executions for states receiving CMS Innovation Grants. Our staff has been part of many discussions with both CMS and state governments on the role of data analytics and data management as these programs are planned, developed and implemented.