Medicaid as a Market: Entrepreneurs Meet the Safety Net

Melissa Buckley, Director, Innovation Fund

October 31, 2016
Melissa Buckley
Melissa Buckley

At the CHCF Health Innovation Fund, we spend our time moving between two very different worlds as we look for ways to foster health care that works for all Californians. In one of those worlds are the health plans and providers who serve people enrolled in the Medi-Cal program. In the other are health care entrepreneurs and investors focused on building for-profit businesses designed to improve health.

These two worlds usually don't intersect. Interestingly, this month's conversations at the annual meeting of California Association of Health Plans (CAHP) and at Health 2.0 (a Bay Area gathering of health care entrepreneurs) began to overlap and to illustrate how the goals of these two seemingly disparate universes have common objectives. Both revolve around what is at the center of today's health care delivery system — the patient — and both are looking for ways to maximize value, both to the patient and to the system at large.

At CAHP, plans serving large numbers of Medi-Cal members pointed to the importance of technology, data, and innovative models of care as keys to success under value-based payment. Plans are using new tools to ensure that members have adequate access to limited specialty resources and effective support for high-cost patients with multiple chronic conditions.

Inland Empire Health Plan CEO Brad Gilbert, MD, for example, spoke about improving value for the plan's 1.2 million members. Gilbert's team spearheaded an effort to integrate primary and specialty care in the community, thereby making care more convenient for members and creating access points that support whole-person care. Inland Empire also partnered with Landmark Health, an innovative provider group company, to pilot the delivery of home-based clinical care for the plan's most medically complex members.

Meanwhile, the 2016 Health 2.0 agenda suggested entrepreneurs now realize that to deliver real value, their solutions must fit cleanly into provider workflow, allow for efficient data sharing, and support patient engagement and population health management for all patients.

At the conference, CHCF drew 200 people from health technology companies, health plans, and providers to discuss the challenges and advantages of the massive and growing Medicaid market. In our presentation, we explored how companies working with plans and providers who serve Medi-Cal members can bring innovation to the safety net and demonstrate measureable results. Download the slides from that conversation (PDF).

CHC Is a Partner in Medicaid Navigation

At that session we paired companies that have drawn investments from CHCF's Health Innovation Fund with one of their safety-net provider customers, asked them questions, and received these answers:

Q: What problems are you working together to solve?
A: Access to specialty care, patient and member engagement, diabetes prevention.

Q: Is Medi-Cal a viable market to sustain a business?
A: Health care is always challenging. You can build a business if you provide real value.

Q: How are these young companies to work with?
A: They are nimble and focused; the key is being able to demonstrate impact and justify the investment.

Q: How do entrepreneurs learn about these opportunities?
A: Networking with the CHCF Health Innovation Fund is a good way.

Q: How is Medi-Cal different from commercial market players?
A: Just a different kind of long and complicated sales process.

The executive director of the Center for Care Innovations, Veenu Aulakh, sent a note to her network after Health 2.0. Buoyed by the convening's expanded focus on the safety net, she wrote:

In the world of health care technology, the needs and challenges of the underserved are finally getting the attention they deserve. And I'm hopeful that all the brilliant technologists, venture capitalists, and health care systems can invest the energy and money needed to address these issues that no one touched by our health care system should have to accept.

Investments are being made now, allowing more innovative companies to invest in good health care and make a profit, with the goal of making health care work for all.

We at the Health Innovation Fund and CHCF at large are excited to be a part of the meeting of these two worlds. Health care that works for all Californians isn't free — and it isn't easy to achieve. It takes resources for research and development, entrepreneurial capital, and innovative solutions in the marketplace. Working together we can bring high-value care to all.