Today in health I. T. We are discussing a scary time right now inside U. P. M. C. S. Medicaid contingency plan. My name is Sarah Richardson. I'm a former C. I. O. For several health care systems, most notably within H. C. N.

Optum and now president of community development at this week health where we host a set of channels and events dedicated to transforming health care. One connection at a time. Today's episode is brought to you by Google Chrome OS. With Windows 10 end of support approaching, healthcare systems can repurpose existing hardware by installing Chrome OS Flex, lowering costs, bolstering security with an OS that's never had a reported successful ransomware attack, all while integrating with their existing apps, solutions, and more.

Learn more at ThisWeekHealth. com. Slash Google dash Chrome O S and I am joined by Kate Gamble, managing editor here at This Week Health. Kate, welcome to the show. Thank you, Sarah. Today we're diving into the growing uncertainty surrounding Medicaid funding and policy changes. UPMC's Brendan Harris has called it a scary time for health systems as federal scrutiny, shifting eligibility requirements, and budget constraints threaten the stability of Medicaid programs.

But what does this really mean for patients, providers, and the future of healthcare? I'm going to start with a big picture. What are the key concerns driving this Medicaid crisis, Kate? Yeah, I'm really glad that we're tackling this because I feel like not only is this so important and such a part of so many people's lives, but I think there's a lot of confusion in addition to the scariness.

One of the biggest issues is that Medicaid has been in flux since the pandemic. With federal emergency measures winding down, states are re evaluated. States are re evaluating eligibility and health systems are feeling the financial strain. So for many hospitals, Medicaid reimbursements are a lifeline, and if those start shrinking, they could see major cutbacks in services.

That's why they called it a scary time, because what's making things worse is that Medicaid policy isn't consistent across states. Some states are more aggressive in cutting costs, which means that hospitals and patients in those areas could face even steeper challenges. Yeah, that's what makes this so complex, beyond just the dollars and cents, this has real implications for patient care.

So we're talking about individuals who depend on Medicaid for chronic disease management, maternal health services, and preventative care. And if they lose coverage, they're more likely to delay treatment, leading to worse health outcomes and higher costs down the road. Which we've seen proven time and again, which it's fascinating to me that the Medicaid conversation, especially the cuts that could be applied to it are always it's such almost like odds with one another, because there is proof to exactly what you just said when you cut funding or you have a harder time getting access to the funding that you need.

Where you lose coverage, people will delay or not get treatment until the acuity is so high, they're going to end up in your ED, which is what we talked about yesterday. And for a healthcare CIO, and I want to bring it over to the tech side, what role does health IT play in helping health systems navigate this type of uncertainty?

So this is where data and analytics are absolutely key. If hospitals can use predictive modeling, they can anticipate which patients might lose coverage and proactively connect with the, connect them with resources. So AI driven tools can also help identify at risk populations and streamline Medicaid re enrollment efforts.

That's a great point because CIOs also have to think about interoperability, which we've also discussed recently, because if the Medicaid policy shifts require changes in eligibility tracking or claims processing, then those systems also have to adapt quickly. And when we see regulatory compliance, et cetera, the things that come first in governance, get top billing in the organization, they have to be rapidly able to adjust and accommodate those changes.

And anytime you're talking about making quick changes. You have to think about cyber security, whether there's a change in policy or financial structure, fraud attempts increase. CIOs need to implement better monitoring to prevent Medicare. CIOs will need to implement better monitoring to prevent Medicaid billing fraud or improper data access.

And if you're not already listening to Drex de Voort's two minute drill. I highly recommend it because he touches on this quite a bit. He always touches on it and it's important because now you've got the financial and operational considerations that are going to layer into that as well. So when you consider the business side, Kate, how do hospitals mitigate the financial risks of Medicaid uncertainty?

So diversification is key. Hospitals can't rely solely on Medicaid reimbursements. They need to be looking at alternative revenue streams like value based care models, community partnerships, and even philanthropic and even fill and even philanthropic funding to support care for underserved populations.

That is a solid strategy because. When we think about the philanthropy and the community partnership, there's also advocacy that falls into all of this. Health systems need to be proactive in policy discussions at state and federal levels to ensure they have a voice in Medicaid reforms. For sure. And even within their own walls, they need to prepare for staffing impacts.

If Medicaid reimbursements drop, hospitals might make to have. Hospitals may have to make tough choices about where to allocate resources. So automation and AI driven efficiency tools will be more important now than ever. When we talk about all these different ways to create a more efficient and excellent organization, you and I often are covering the automation, the AI, the data modeling, for the ability to either not have to fill open roles or to reallocate staffing to other areas.

When we think about the burnout and the shortage issues as well, now you've got the element of reimbursement. And so when I consider all of these tools that are available, you're handling what's happening now. And to a degree, you're already future proofing your organization for what else may happen next.

What's been interesting about a career in healthcare for over 25 years is that. It's actually not super predictable. There's so many things about it that are, and yet there's so many things about it that we feel like things happen to us. And when you get into a head space where you realize no matter what happens, you can handle it.

And I do believe that was start over. I do believe that was reinforced by how we handled the pandemic, the innovative creativity that lives within health systems. When you take, walls of the room away and really allow yourself to think. a little bit broader in terms of the solutions you're providing.

That's why something like these efficiency tools are so important, regardless of what is driving them. Do them telehealth was for us pre pandemic. it was almost impossible to get people to want to really utilize telemedicine pre pandemic, and then it became something that everybody needed to survive, literally financially, within their health care systems.

Yeah there's a reason why he called it scary. It really is. And reimbursement is unpredictable. So if you're a CIO, if you're a leader, what you need to do is get ahead of the data. So understand your patient population, anticipate coverage losses and develop outreach plans. Second, invest in flexible health IT solutions that can quickly adapt to regulatory changes.

And engage in advocacy efforts to help shape policies that impact both the hospitals and the communities they serve. And interestingly, we had a recent keynote with Anish Chopra, who's the head. Who's the chief strategy officer at Arcadia. And he talks a lot about the Medicaid issue and provides some clarity.

And if we haven't said it yet, which we probably have, reach out to your colleagues. If you don't have their information, get in touch with us because that's what this community is about. Sharing knowledge and helping each other solve problems. And Medicaid is one of them. Medicaid is one of them. And in a recent city tour dinner, Drex noted that the quote of the night, Was from a CIO who said, when I talk to physicians who want something and they've already decided what they want.

They say, I want you to meet my five friends, risk, legal, privacy, compliance, and InfoSec, because you don't make any kind of decision without them. That is true across the continuum of what you and I cover in the news. It's also very true for something like, how do you make sure you have a space where you can effectively manage and mitigate whatever's occurring in the changes coming to Medicaid?

I absolutely love that quote. And I'm going to tuck that one in my back pocket. It is the back pocket quote for sure. It happens all the time. Kate, thank you for joining me and talking about this ever evolving landscape and conversation with Medicaid, to a degree, Medicare, and all policy changes that are affecting reimbursement and the

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