Grant Supports Efforts to Create Atlas of Medicaid Spending.
Grant Supports Efforts to Create Atlas of Medicaid Spending
The new digital platform developed by researchers at SPH and Weill Cornell Medicine will enable policymakers and others to quickly identify how Medicaid spending and use vary across states, counties, plans, and populations.
Researchers from the School of Public Health and Weill Cornell Medicine have been awarded more than $950,000 from Arnold Ventures to create a “Medicaid atlas”—a national, data-driven web platform that will illuminate how healthcare use and spending vary across Medicaid programs, plans, and populations.
The project launches at a moment of growing urgency for Medicaid policymakers, due to significant funding cuts enacted under the One Big Beautiful Bill Act last year—nearly $1 trillion over 10 years—which is the largest reduction in federal Medicaid spending in US history.
As states face increasing fiscal pressure, leaders need actionable data to understand where spending is high, why it varies and where opportunities exist to improve care.
“The One Big Beautiful Bill Act puts unprecedented pressure on state budgets and will force difficult decisions with respect to Medicaid spending,” says Sarah Gordon, associate professor of health law, policy & management (HLPM) at SPH and colead of the atlas project, as well as the codirector of the BU Medicaid Policy Lab, an initiative launched in 2021 that examines the impact of policy changes on health insurance coverage, access, quality, and eligibility for low-income populations. “Medicaid programs have always been innovative by doing more with less, but will need to identify opportunities to be even more so, given the current fiscal environment,” she says. “Good data is a key part of that.”
“Medicaid is a massive program. It’s one of the biggest line items in states’ budgets. And yet we still lack great visibility into what drives spending variation,” says William Schpero, an assistant professor of population health sciences at Weill Cornell Medicine and colead on the project. Schpero also directs the Medicaid Policy Impact Initiative, a new cross-campus Cornell program aimed at supporting evidence-based policymaking in Medicaid.
Understanding those drivers has been difficult for researchers because Medicaid is highly fragmented across states and often delivered through private managed care plans. Two patients with similar health needs may generate very different spending depending on where they live and which plan they are enrolled in. At the same time, information about healthcare spending, use and quality has historically been siloed across states and insurers, forcing policymakers to rely on time-intensive, custom analyses to answer even basic questions.
This approach does not always support the rapid-cycle policy environment many Medicaid programs operate in. “With the atlas, we want to make it possible to go from months-long studies to making helpful data insights one click away,” Gordon says.
That goal has become more feasible in recent years with the release of high-quality national Medicaid claims data from the federal government, which for the first time enable consistent analysis across states. In 2022, Gordon and Schpero helped start the Medicaid Data Learning Network, a national consortium of researchers dedicated to developing best practices for analyzing federal Medicaid claims data. The research produced by this network has demonstrated the potential impact of national Medicaid data analyses to inform policy.
“These data have proved to be a major catalyst for conducting timely Medicaid research that can directly inform state decision-making,” says Schpero, who is also an associate director at the Cornell Health Policy Center, which houses the Medicaid Policy Impact Initiative. “Our hope is that this tool can be a valuable resource for Medicaid leaders to understand variation within their state and benchmark to other states, all in a one-stop, easy-to-use dashboard.”
Over the first two years, the research team will develop a set of 10-15 measures capturing major drivers of Medicaid spending and utilization. These measures will be selected in collaboration with state Medicaid leaders to ensure they help answer high-priority policy questions.
“The goal of this project is to put Medicaid policy and financing insights at the fingertips of policymakers, researchers, journalists and the public,” Gordon says.
The atlas will allow users to examine variation across states, counties, plans and enrollee populations—and to identify patterns that may signal opportunities to improve efficiency and care delivery. States could use the atlas to benchmark spending, evaluate managed care plans and identify high-value models of care.
There’s precedent to think this approach will work, Schpero says. A decades-long project called the Dartmouth Atlas of Health Care used claims data to identify opportunities to lower spending while maintaining or improving quality in the Medicare program. Some of the project’s findings laid the groundwork for components of the Affordable Care Act.
“There’s a rich history of using national claims data to inform policymaking,” Schpero says. “To date, much less of this has happened in Medicaid. There is a lot that we can learn about Medicaid policy from these data and that states can learn from each other.”
The atlas project is part of several other current and past initiatives by the Medicaid Policy Lab, which is also codirected by Paul Shafer, associate professor of HLPM, and Kevin Nguyen, assistant professor of HLPM. These projects have examined numerous aspects of Medicaid utilization and health outcomes, including racial inequities, Medicaid managed care, substance use disorder outcomes, pregnancy and postpartum care, and more.