Gainwell Technologies

Serena Barden, PharmD, BCPS, a member of Gainwell Technologies PBM Clinical Services team, will also be presenting at AMCP Annual 2026 on Wednesday, April 15 at 6:30 p.m. CDT. Her session, Uncomplicating the Complications of Systemic Lupus Erythematosus for Managed Care: A Focus on Nephritis, will review the epidemiology, classification criteria, clinical manifestations, and disease progression of systemic lupus erythematosus with a focus on the evolving use of biologics for lupus nephritis. If you’re attending AMCP, we hope to see you there!

Medicaid serves over 72 million people across 50 states. Behind every appointment, prescription, and moment of care, there is a personal story. At Gainwell, we know managing this vital safety net is incredibly complex. That's why we're dedicated to transforming Medicaid through innovation, data-driven insights, and streamlined systems. Our new 2026 company video highlights how we partner with states to build a stronger future for health and human services. We focus on the technology so you can focus on care. Our work centers on three key areas: • Cutting through administrative complexity to simplify daily operations • Turning massive amounts of data into actionable insights that fuel better public health outcomes • Modernizing systems so they don't fail the people who need them most We are committed to delivering meaningful results. When your systems work seamlessly, it's possible to identify health issues earlier, improve care delivery, and help more people get the support they need. Watch our 2026 video to see how we're advancing what's possible in Medicaid: https://lnkd.in/gd-CbG8X #Medicaid #HealthTech #Innovation #GainwellTechnologies

Did you know 1/3 of medical providers report significant dissatisfaction with Medicaid administrative processes? This isn't just an inconvenience; it's a direct threat to network stability and care access. Our latest whitepaper, "The Silent Barrier," analyzes feedback from hundreds of providers nationwide. The findings are clear: providers dissatisfied with administrative friction are almost 4X more likely to leave Medicaid. Reducing administrative burden is a core strategy for strengthening provider networks and ensuring beneficiaries have access to care. States that prioritize modern, streamlined systems are building a foundation of trust with providers. Ready to explore the data and see what providers are looking for to improve their experiences? Download the full whitepaper to learn more: https://lnkd.in/gScpkWUJ #Medicaid #HealthcareInnovation #ProviderExperiences

New Mexico is advancing Medicaid program integrity with the deployment of a comprehensive HMS fraud, waste, and abuse (FWA) suite powered by FraudCapture®. This modernized approach brings together AI-powered fraud detection and analytics, clinical claim reviews, residency and eligibility verification, Coordination of Benefits, and quality reporting into a unified solution—giving the state greater visibility, stronger oversight, and earlier detection of risk across its Medicaid program. By incorporating artificial intelligence, advanced analytics, machine learning, and nationally recognized quality measures, New Mexico is strengthening safeguards for public resources while supporting access to high-quality care for the people who rely on Medicaid. We’re proud to partner with New Mexico on this important step forward in Medicaid modernization. Read more about the deployment and its impact: https://lnkd.in/gY9kytrU #Medicaid #ProgramIntegrity #GainwellTech #FraudWasteAbuse #AI #DigitalTransformation #PublicHealth

We’re looking forward to AMCP 2026 and the opportunity to connect, learn, and share insights with the managed care community. Amanda Williams from Gainwell Technologies will be presenting twice at this year’s conference: • Monday, April 13 | 2–4 p.m. CST Optimizing Cardiorenal Metabolic Health: A Managed Care Guide to Integrating SGLT2 Inhibitor Therapy • Wednesday, April 15 | 6–8 a.m. CST Optimizing Outcomes in Hereditary Angioedema: Managed Care Approaches to Diagnosis, Treatment, and Patient Quality of Life These sessions will explore practical, evidence-based strategies to support better outcomes and improve patient quality of life across complex therapeutic areas. We’re excited to contribute to the dialogue and learn alongside peers who are shaping the future of managed care. If you’re attending AMCP, we hope to see you there. Learn more about the conference: https://lnkd.in/gkzraxnQ

Implementing medical frailty exceptions for Community Engagement Verification is an administrative hurdle for state agencies. When systems fall short, vulnerable populations risk losing essential health benefits. Relying on basic claims data alone can create a gap that leaves many medically frail individuals unrecognized. States need a complete view of a member's health history to make accurate decisions. To solve this puzzle, states can leverage enriched data sources, artificial intelligence, and transparent clinical logic to bridge operational systems, close the disability gap, and ensure consistent, defensible exemption decisions at scale. Read our latest blog to get more insights on building adaptable workflows and protecting vulnerable individuals: https://lnkd.in/dZJ4Kfp8 #Medicaid #HealthTech #PublicPolicy

Rural Medicaid leaders have to do more with less. Small populations mean less data to work with. And, those populations have complex care needs, especially when mental illness and substance use disorder come in to play. Traditional analytics aren’t enough to support informed decisions in this environment. In our latest article, we explain how multifactorial longitudinal analytics help rural Medicaid programs to connect risk, utilization, and outcomes to create measurable impact. Read the full piece: https://lnkd.in/gM7t2KNy #Medicaid #RuralHealth #DataDrivenCare #HealthOutcomes

Gainwell Technologies is proud to launch a new AI-powered solution to help states accurately identify medically frail Medicaid members—supporting compliance with new H.R. 1 requirements and protecting individuals whose health depends on uninterrupted care. The Gainwell Medical Frailty solution is available standalone or as part of our full Community Engagement Verification platform. We’re also excited to share that the clinician-built logic governing this solution—a comprehensive set of rules covering 2,000+ medical, behavioral health, and pharmacy codes—is now available to all states at no cost, regardless of technology partner. This is about more than automation; it's about ensuring people with serious health conditions continue to get the care they need. Learn more about how we’re helping states verify medical frailty with accuracy, compassion, and innovation: https://lnkd.in/gjmBJzmR

Stopping fraud, waste, and abuse in Medicare and Medicaid requires a proactive approach to protect taxpayer dollars and the people who rely on these essential programs. Insights from a recent congressional hearing underscore how advanced data analytics, rigorous provider screening, and strong cross-agency collaboration are securing the future of public healthcare. Read our full summary to see how these proactive strategies safeguard program integrity: https://lnkd.in/gBY2-Hfu #Medicare #Medicaid #GainwellTech

During the recent Medicaid redetermination, 69% of people who lost coverage were disenrolled for procedural reasons—often just paperwork, not eligibility. Fragmented data blocks real-time decisions and impacts care. A phased modernization using lakehouse architecture and AI can help states prevent coverage loss, improve compliance, and deliver whole-person care. Read the full white paper, co-authored by Gainwell Technologies and Databricks, to see how connected data drives better outcomes: https://lnkd.in/gtG-B35m #Medicaid #DataAnalytics #GainwellTech #Databricksx