The Math of Medicare and Medicaid Access: It all Adds Up

Economics isn’t always simple. But at its basic level, it’s not a hard concept to grasp. It is the relationship between supply and demand. Supply is how much something is available in the market. Demand is how much it’s wanted by consumers.

So it often boggles my mind that when we when talk about healthcare, the basic economics of supply and demand never come into play. Supply is the number of physicians, extenders, nurses, and rooms that are available. Demand is the number of people who need care.

People tell me that it isn’t that simple … but I disagree. I think one of the most compelling dilemmas in healthcare today is pretty straightforward. There are too many people who need to be seen by a doctor (excess demand). And there are too few physicians available to see these patients (supply). So what happens? Right now, there are many people who need care — basic care — and are not receiving it.

When this happens, which individuals are drawing the short-end of the stick when there is excess demand? Often those who need it most. The individuals who have Medicare and Medicaid. This is something we all assumed was happening, but recent studies have confirmed these assumptions. A recent Merritt Hawkins study states that in 2017 only 53% of practices accept Medicaid patients and 84% of Medicare patients.

This is wrong. It’s wrong to deny care to anyone. But it is especially wrong to deny care to those who need it most. So how do you fix this math problem that has turned into a huge sociological problem?

With math.

By maximizing big data and leveraging predictive analytics, we can understand the right way to utilize physicians and extenders properly. Use the same analytics to understand no-show rates so you can properly schedule based on these factors. Predict what visits with what symptoms will come in at what times, so that patients with the greatest need get help as soon as possible.

Instead of focusing on the specifics of someone’s insurance, focus on the specifics of a person’s need. And then prioritize care based on that factor, along with leveraging math and technology at the time of scheduling to increase efficiency and access to all.

This is what we’re doing at Opargo: fixing healthcare’s access and prioritized care problems with math and integrated technology. And ensuring that people who need care the most get it first.