Rethinking Care Delivery: Digital Innovation for a New Era of Medicare and Medicaid

As the U.S. healthcare system continues to adapt to the economic and political climate of 2025, one thing is certain: Medicare and Medicaid programs are under increasing financial pressure. A combination of federal budget constraints, rising healthcare costs, and growing enrollment in public programs, particularly among aging adults and individuals with complex health conditions, has forced a critical shift in how care is funded and delivered.

According to recent data from the Centers for Medicare & Medicaid Services (CMS), Medicare enrollment is projected to reach over 80 million by 2030, while Medicaid enrollment surged during and after the pandemic, creating long-term financial strain. In response, many states and federal policymakers are pursuing cost-containment strategies, including reducing reimbursement rates, tightening eligibility, and cutting funding to care coordination programs.

For health plans, provider groups, and managed care organizations, this means delivering the same, if not better, quality care with fewer resources. The stakes are high, with lower quality ratings (like Medicare STARs and HEDIS(R) scores), missed care gaps, and reduced patient satisfaction all leading to potential financial penalties and a loss of trust.

A New Model for Engagement in a Budget-Constrained World

In this context, traditional models of care, which are heavily reliant on in-person interactions, manual outreach, and resource-intensive call centers, are quickly becoming unsustainable. Organizations are now turning to scalable, digital-first approaches to engage members and meet care mandates without overburdening staff or increasing overhead.

Digital engagement, especially when grounded in behavioral science, is no longer optional—it’s essential. Solutions that can engage individuals in real-time, drive care plan adherence, and flag people needing additional support or urgent intervention due to early signs of crisis, offer not only clinical and operational advantages, but financial ones too.

“Given the demands on increasingly stretched care teams and the complexity of managing individuals with multiple comorbidities, traditional care models are no longer viable. Scalable, digital-first solutions grounded in behavioral science are essential—not optional—for driving adherence, identifying early risk, and achieving clinical, operational, and financial goals,” said Michael S. Barr, MD, MBA, President & Founder of MEDIS, LLC. and Strategic Advisor for GoMo Health.

Leveraging Behavioral Science to Scale Care

GoMo Health is an example of a company applying evidence-based behavioral science to support individual and population health goals through digital engagement. The BehavioralRx® methodology personalizes care based on each individual’s emotional, cognitive, and situational needs and is delivered via secure text and email, with interactive tools that reinforce positive behaviors over time.

What sets GoMo Health apart is its ability to serve as a single, scalable platform – or hub — that supports a wide range of clinical and social programs. A common challenge for health plans and payers is being presented with multiple, disconnected solutions—each focused on a different condition or population. The GoMo Health Engagement Hub addresses this by offering a unified platform that can be used to digitally navigate management of multiple conditions, enabling organizations to engage members with vastly different needs, centralizing care and communications with the same technology, care team, and implementation partner. This hub model also allows for data collection and analysis across the continuum of care delivery, providing valuable insights and trends throughout the patient experience.

This approach is especially valuable in Medicaid and Medicare populations, where chronic conditions, social determinants of health (SDoH), behavioral and mental health challenges intersect. GoMo Health programs have been used successfully across multiple population segments, delivering measurable results without increasing labor costs, allowing organizations to allocate resources to be more effective and efficient. Explore a GoMo Health program in action:

Use Case: Amerigroup Early Detection Program
To address the unique needs of children with autism and their caregivers, Amerigroup Georgia partnered with GoMo Health to implement a digital early detection and intervention concierge program. The initiative reached more than 89,000 families, with the following results:

• 99% retention rate across early detection and intervention tracks
• 142 emergency or crisis events intercepted via real-time messaging
• 318 families assisted in accessing pediatric specialists and avoiding missed visits
• 19,700+ resource links clicked, demonstrating active program engagement
• 218 caregivers enrolled in a stress support track focused on caregiver mental health

In a population where care continuity is especially vulnerable, this program helped reduce crisis events and improve access, while lowering costs and care team strain.

Innovating Toward Sustainability

CMS continues to emphasize value-based care, rewarding organizations that deliver better outcomes at lower cost. But to achieve those outcomes, particularly with reduced funding, organizations need tools that are flexible, scalable, and automated.

Digital engagement platforms by GoMo Health help extend the reach of care teams without requiring additional full-time staff. These programs can be rapidly configured for specific populations—whether that’s postpartum moms, seniors with chronic conditions, or individuals managing behavioral health challenges.

With Medicare Advantage STAR Ratings and Medicaid managed care contracts increasingly tied to quality metrics, digital programs that proactively support adherence, close gaps, and elevate the member experience are becoming core to survival—and success.

“Performance in Medicare Star Ratings includes measures that can be affected by patient engagement, particularly medication-sensitive measures for which adherence is critical. Digital-first engagement strategies offer a scalable way to influence behaviors, improve adherence, and address multiple quality measures simultaneously to drive performance across quality and financial dimensions,” said Michael S. Barr, MD, MBA.

References:

1. Centers for Medicare & Medicaid Services. (2022, March 28). CMS Office of the Actuary releases 2021–2030 projections of national health expenditures. Retrieved from: https://www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2021-2030-projections-national-health-expenditures
2. Kaiser Family Foundation. (2022, March 1). Analysis of recent national trends in Medicaid and CHIP enrollment. Retrieved from: https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/
3. Centers for Medicare & Medicaid Services. (2025, January 15). CMS moves closer to accountable care goals with 2025 ACO initiatives. Retrieved from: ms-moves-closer-accountable-care-goals-2025-aco-initiatives loser-accountable-care-goals-2025-aco-initiatives
4. Kaiser Family Foundation. (2022, February 24). What to know about Medicare spending and financing. Retrieved from: https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-spending-and-financing/