Blockchain in Medicaid

Last week, I attended a Women in Healthcare – DC event titled “Blockchain in Healthcare.”  While I was familiar with blockchain through Bitcoin and Dogecoin, I had never devoted much time to considering possible applications to healthcare.  The presentation and discussion were led by:

  • Jeremy Epstein, CEO of Never Stop Marketing, who works with top-funded blockchain companies, such as OpenBazaar and Storj
  • Jody Ranck, author of “Connected Health: How Mobiles, Cloud Computing and Big Data will Reinvent Healthcare” and “Disruptive Cooperation in Digital Health” and chair of the upcoming Healthcare Blockchain Summit
  • Jason Goldwater, Senior Director at the National Quality Forum

Coming out of the event, my mind was racing with the potential applications to Medicaid, particularly program integrity.  Stay tuned for my thoughts on how blockchain could:

  • Improve quality of care and application experience for Medicaid participants
  • Reduce administrative costs
  • Reduce wasteful medical / long term care costs
  • Minimize administrative burden on providers (which could potentially lead to a larger pool of Medicaid providers and greater access to services for Medicaid participants)
  • Significantly decrease the length of time it takes to pay providers

In the meantime, this article provides a good overview, including a video, of what blockchain is (and is not).


Long term care costs

My work to date has focused on home and community-based services, which are a subset of long term care services.  Long term care (LTC) refers to services that help the elderly and those with disabilities meet health or personal needs.

These services can be provided in a variety of places, such as:

  • Your home
  • A nursing home
  • An assisted living facility
  • An adult day care center

Why should you care

If you do not have insurance to cover long term care, you will have to pay for it out-of-pocket (or rely heavily on unpaid family caregivers).  National spending on long term care increased by 7.7% between 2013 and 2014, and it is estimated that 70% of the 65+ population will use LTC in their lifetime.

  • Regular health insurance doesn’t cover long term care.
  • Medicare only covers short nursing home stays or limited amounts of home health care when you require skilled nursing or rehab. It does not pay for custodial care, which includes supervision and help with day-to-day tasks.
  • You can get help with long term care from Medicaid, but only after you have exhausted most of your savings. Many providers also choose to not take Medicaid payments, so your provider options will be limited.

The viz

Genworth, an LTC insurance company, produces an annual report of LTC costs based on a survey of over 15,000 LTC providers.  I used reports from 2010-2016 to build out the following data visualizations, which summarize national costs, compare costs across states and estimate how much you might spend on long term care in your state.  The data covers the following services:

  • Home health aide: Assistance with bathing, dressing, transferring and toileting, but not with catheters or injections
  • Homemaker: Assistance with shopping, finances, cooking, errands and transportation
  • Adult day health center: Structured day programs (including health, social and other support services) designed to meet the needs of adults who are functionally and/or severely cognitively impaired; services are intended to enable individuals to live more independently in the community
  • Assisted living facility: Licensed facilities generally provide housing and additional services; each state has its own licensing standards
  • Nursing home: Medicare-certified nursing facilities, which make up greater than 90 percent of all nursing homes in the U.S., and include housing, three meals a day, laundry, sundries, basic nurse supervision and generic non-prescription pharmaceuticals; the data is divided by costs for a private (single occupancy) bedroom and a semi-private (double occupancy) bedroom

(click the image to interact with the data)