A Blueprint for Cost-Effective and Equitable Healthcare Delivery through Technology Automation

Purpose: The primary purpose of this paper is to explore how automation in Medicaid redetermination and risk-sharing models can enhance operational efficiency, reduce manual errors, and align financial incentives with patient outcomes, thereby driving cost containment and improved provider accountability. Methodology: The study adopts a comprehensive qualitative approach, leveraging a strategic analysis of advanced data systems, cloud-based platforms, and scalable integration frameworks. The paper synthesizes insights from existing literature, industry reports, and case studies to propose an integrated model for modernizing Medicaid management. Findings: The integration of automation in Medicaid redetermination significantly improves operational efficiency, reducing processing times by as much as 30% and enhancing eligibility accuracy through real-time data integration and predictive analytics. Risk-sharing models, including shared savings contracts and performance-based incentives, align financial objectives with patient outcomes, reducing healthcare costs by up to 10% while improving provider accountability and patient satisfaction. Unique Contribution to Theory, Practice, and Policy: This paper advances theoretical understanding by proposing a unified framework that integrates automation and value-based care within Medicaid, highlighting the transformative role of predictive analytics and cloud-based platforms. Practitioners are provided with a blueprint for implementing automated Medicaid redetermination and risk-sharing models, showcasing best practices for achieving operational efficiency, financial sustainability, and health equity. The paper outlines policy implications, emphasizing the need for regulatory frameworks that support data privacy, interoperability, and continuous innovation, paving the way for resilient public healthcare systems. By leveraging automation and value-based care frameworks, this blueprint offers a path to a more efficient, accountable, and patient-centered Medicaid program, paving the way for a resilient public healthcare system