Opportunities for Emerging Technologies in the Medicaid Market

Medicaid covers one out of every five Americans and accounts for more than $550 billion in federal and state spending annually. To date, however, investors and entrepreneurs have largely ignored this market, focusing instead on developing solutions for private and commercial customers.

Although the federal rules and funding for Medicaid may change, the larger trends driving its payers and providers to innovate will persist. In particular, the demand for emerging technologies that increase access and improve value will remain high. This is especially true in California, which has deeply committed to expanding coverage and widely embraced the shift to managed care.

We have compiled the following resources to bridge the gap between safety-net stakeholders, who best know the needs of the Medicaid market, and innovators, who can offer scalable solutions that have impact:

• 6 Reasons the Medicaid Market Is Ripe for Innovation: A high-level introduction to the market and the underlying trends that make it uniquely primed for innovation, especially in California. (See sources below.)
• Primed: A new and growing collection of market intelligence reports, each diving deeper into a particular area of Medicaid within which emerging technology can have an outsized impact. The following are our first two Primed features:
  • Medicaid Pilots Open Door for Innovation in California: An overview of the pilot opportunities made possible by California’s embrace of value-based care, which prioritizes quality and efficiency over quantity.
  • Addressing Social Factors in the Health Care Safety Net: A deep dive into the opportunity for emerging technologies to help providers understand and address the many social factors that affect patients’ health outcomes.
• Innovation at Work in Medicaid: An interactive infographic outlining some of the market’s greatest areas of opportunity, and highlighting select start-ups already making an impact.
• Principles of High-Value Innovation: An overview of the key criteria entrepreneurs should consider when developing technology-based solutions for the safety net.

Each of these resources, as well as a PowerPoint version of the 6 Reasons handout and a printable version of Innovation at Work in Medicaid, is available under Document Downloads.

As new opportunities and trends within the Medicaid market emerge, we intend to build upon this collection of resources. We welcome your ideas and observations.

Sources

• “Managed Care,” Medicaid and CHIP Payment and Access Commission, accessed October 4, 2017.
• “Medicaid Pocket Primer,” Kaiser Family Foundation (KFF), last modified June 9, 2017.
• California Health Insurers: Two Years After Reform, California Health Care Foundation, April 2017.
• Funding the Medi-Cal Program (PDF), Public Policy Institute of California, March 2017.
• Medi-Cal Monthly Enrollment Fast Facts (PDF), DHCS, March 2017.
• “Medicaid Financing: The Basics,” KFF, December 22, 2016.
• “50th Anniversary of Medi-Cal,” California Department of Health Care Services (DHCS), last modified October 3, 2016.
• The Medi-Cal 2020 Waiver and the Work Ahead for Public Health Care Systems, California Assn. of Public Hospitals and Health Systems and the California Health Care Safety Net Institute, February 2016.
• “Total Medicaid Spending: FY 2016,” KFF.