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The Power of AI in Medicaid Management Information Systems (MMIS)

Updated: Jan 30

Healthcare worker consulting an AI image on a screen

Artificial intelligence (AI) and the use of it has become widespread among different industries throughout recent years. We continue to see large amounts of growth in its usage and capabilities throughout not just the U.S., but the whole world. In fact, the global AI market size is projected to grow from $515.31 billion in 2023 to $2,025.12 billion by 2030.

With nearly 150 million Americans enrolled in Medicare, Medicaid, and the Child Health Insurance Program, it makes sense why the Centers for Medicare and Medicaid Services (CMS) would want to utilize AI technologies. In the healthcare industry, many great AI discoveries have been made and used, including robotic surgeries, data management automation, call center chatbots, diagnostics, and virtual nursing. AI has been especially relevant to the growth of Medicaid Management Information Systems (MMIS). Let’s discuss why and how AI is being used in MMIS.

How AI Benefits Medicaid

CMS possesses a large data portfolio due to the vast amount of patients enrolled in their healthcare services. With the help of AI, CMS is able to leverage the data to advance health equity, expand coverage, and improve health outcomes for their enrollees. These technologies can automate tasks that might otherwise be time consuming for both members and their care providers, making it easier to focus on patients and their experiences. Overall customer satisfaction improves when processes are made more efficient with AI.

A few aspects of the patient experience that AI helps improve are personalized care, patient monitoring, and identity detection.

  • Personalized Care

Rather than providing predetermined care from certain enrollment plans, patients can have a more personal experience relevant to their own health.

  • Patient Monitoring

Remote and digital monitoring make patient check-ins and common health issue services more accessible.

  • Identity Detection

Systems are more efficient at handling data and identifying fraud or misuse claims.

These are just a few of the ways that AI benefits Medicaid services, in addition to improved health outcomes and cost reductions. There are already many effective applications of AI in Medicaid, and more continue to emerge to help advance the processes for these patients and providers.

Applications of AI in Medicaid

CMS has utilized many AI systems in their health services, and continues to introduce more advancements and programs using AI and machine learning technologies. They have used AI to better detect strokes and diabetes; by speeding up the process of diagnosis and treatment, patient disabilities and recovery times are significantly reduced. This improves health outcomes for many affected patients.

In addition, machine learning systems have been used to identify fraud and/or abuse in Medicare and Medicaid programs. By having these tasks be automated and handled by AI, there is more freedom for human resources to be allotted to other parts of an organization that require them.

Bias and Ethics in AI

With all of the talk of the benefits of AI, it is also important to discuss its flaws. Incomplete data sets have the potential to cause machine bias when using AI in healthcare. It is crucial to make sure that all of the data is accurate and relevant to avoid this. By also using data that is highly representative of the expected population, more accurate and unbiased results will be obtained. Educating the workers that are involved with AI in these healthcare processes will help ensure that the use of it is ethical and responsible. Consistent testing of these systems is another aspect that will help get these results.

Artificial intelligence comes with many benefits when utilized in Medicaid services, improving the process for everyone involved. Providing patients with personalized care and increasing the accessibility of health resources are just a couple of the advantages to utilizing AI and machine learning. Ensuring unbiased and ethical usage of these technologies helps advance Medicaid services to new heights with each new discovery.

Did you know that Sedna Consulting Group has over 15 years of experience in providing digital solutions for Medicaid Management Information Systems? We have worked with large implementation companies of MMIS nationwide, and are attending the Medicaid Enterprise Systems Community (MESC) conference in Denver, Colorado on August 21 - 24 to share our experience and ideas. We hope to see you there, but if you are unable to make it you can also send us a message on LinkedIn or Instagram to chat with us to learn more.



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