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Aug 2015 - Business Strategy - Doc # HI257482

Business Strategy: Business Lines of the Future — Emerging Opportunities and Key Considerations for Medicare and Medicaid Plan Management

Authors: Deanne Kasim, Lynne Dunbrack

Abstract

This IDC Health Insights report examines emerging opportunities and key considerations for payers participating in the Medicare and Medicaid programs and the related IT vendors.

"Innovations in Medicare and Medicaid, particularly as funded and mandated by the Affordable Care Act (ACA), are continuing to shape the marketplace for payers and the IT vendors supporting them. CMS' CMMI continues to implement pilot programs and/or issue regulations regarding innovative payment and care delivery models, both of which are changing business models for payers, providers, and vendors. Successful payers need to stay abreast of findings and rules coming out of the U.S. Department of Health and Human Services (HHS) regarding Affordable Care Act–related pilots and programs, including the State Innovation Models (SIM) for Medicaid and the Independence at Home Demonstration program for Medicare, and other programs as they evolve. It has become clear that a true population health management approach for both of these programs will continue to grow in the future, which has significant implications for all industry stakeholders." — Lynne A. Dunbrack, research vice president, IDC Health Insights

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