Medicaid Road Trip

Across America, experts identify tech innovation opportunities in Medicaid

Participant at PRIMED Nashville event places notes on easel.
Andrey Ostrovsky, MD, former chief medical officer of Medicaid for the Centers for Medicare & Medicaid Services (CMS), facilitates a breakout group at the Primed Roundtable in Nashville, Tennessee. Photo: Alan Poizner.

There is a common saying among people who work in Medicaid: “Once you’ve seen one state’s Medicaid program, you’ve seen one state’s Medicaid program.” While Medicaid is a federal program, it is administered by states, meaning that each of the 50 states plus the District of Columbia delivers Medicaid differently. Those differences determine everything from who can enroll to how much a state spends on medical care for beneficiaries. Researchers endlessly publish lists comparing and ranking the services provided by various Medicaid programs.

Yet this tendency to focus on the differences belies the fact that all state Medicaid programs face the same fundamental challenges. Those include the opioid crisis, unequal access to services, and the persistence of high-cost care yielding low-quality outcomes.

In every part of the US, people committed to Medicaid’s mission are wrestling with the same basic question: How can we deliver higher quality, more accessible, less costly care to the people who need it most? If all of us are struggling with the same question, then we can all benefit from hearing one another’s best answers to it.

PRIMED Nashville_Body Large
A breakout group at the Primed Roundtable in Nashville included Wendy Long, MD, MPH, director of Tennessee’s Medicaid program TennCare (bottom left); Kara Carter, MBA, MSc, senior vice president of strategy and programs at CHCF (far right); Amber Cambron, CEO of BlueCare Tennessee (third from right); and former TennCare Director Darin Gordon (second from left). Photo: Alan Poizner.

That is why we recently launched Primed: A Roundtable Series on Tech-Enabled Innovation in Medicaid in partnership with Village Capital and Speire Healthcare Strategies. We are hitting the road to hear from other states’ health plans, providers, entrepreneurs, investors, and Medicaid officials about how technology could improve all 51 Medicaid programs. Through those conversations, we hope to identify a shared set of problems for which technology might hold scalable solutions.

Why We’re Talking Tech

We are focused on technology-enabled innovation because we believe sustainable improvements to Medicaid require change at both the top and bottom of the system. Policy innovations drive change from the top down, but they alone are insufficient. Technology innovations — the specialty of the California Health Care Foundation’s Health Innovation Fund — act as a complementary catalyst. They can drive change from the front lines of health care — whether in patients’ homes, exam rooms, or medical records.

There is exciting national momentum right now around technology-enabled innovation in Medicaid, and we want to build on it. Just last month, 17 health systems signed on as inaugural members of the Medicaid Transformation Project. Led by Andy Slavitt, the former CMS Administrator, the project seeks to “change the health and care of the Medicaid population by leveraging digital solutions and innovative care models.” Other recently launched endeavors using technology to improve Medicaid include Google-backed start-up Cityblock Health and the investment firm Town Hall Ventures.

We know that Medicaid is missing out on many promising innovations already benefiting patients and providers in the commercial and Medicare markets. We have heard first-hand from the companies responsible for such innovations that they find the potential for impact in Medicaid appealing. At the same time, they also see Medicaid’s 51 sub-markets and fear a splintered business landscape that will be  incompatible with their need to scale quickly in order to survive.

Seeking Clarity and Common Ground

By clarifying and highlighting the shared opportunities for innovation that exist across states’ Medicaid programs, we can better focus the attention of entrepreneurs and the resources of funders. They can target their funding and tailor their technologies to deliver the most value for the greatest number of people. Once identified, those shared priorities can also be used to focus other efforts, such as policy advocacy, to reduce barriers to innovation in Medicaid.

That work of clarifying and prioritizing is what we hope to launch with the Primed Roundtable Series. We aim to map out that common ground where innovative solutions can create scalable, sustainable impact and drive improvements in Medicaid nationwide. A series of four roundtables began with an August event in Nashville, and future meetings will be held in Boston, Denver, and Washington, DC. The series will conclude in November.

After the roundtables are complete, we will announce which problems were prioritized as ripe for technology-enabled innovation. We will then work with peers to marshal our resources to identify, support, and evaluate solutions to those problems.

A Hint of What’s Ahead

Our Nashville Roundtable surfaced numerous challenges. Here’s a sneak peek at top priorities for tech-enabled innovation among the plan, provider, and Medicaid agency participants:

  • Member identification and engagement: Plans and health care providers desire better tools for locating members and maintaining accurate contact data for them, especially when they move or roll off coverage. They also want to better leverage that information to motivate members to use the right health and social services at the right time.
  • Data integrity and shareability: Government agencies, social service non-profits, plans, and health care providers want to easily exchange information about the people they serve to close gaps in care. Barriers to achieving that goal include mistrust of other entities’ data quality and concerns about privacy, especially around substance use records.
  • Data analysis and actionability: As providers and plans gain access to growing amounts of data about their patients, they are expected to use those to deliver lower-cost, higher-quality care. But, many entities feel ill-equipped to manage, interpret, and meaningfully act on those data.

Stay tuned to our website to find out how Tennessee’s challenges compare to those prioritized by other states we will be visiting later this fall. Opportunities to engage with the findings will include an online report and a live event at the J.P.Morgan Health Care Conference in San Francisco in January 2019.