A national collaborative of 17 major health systems recently unveiled a two-year initiative that it anticipates will transform the Medicaid program by leveraging shared digital solutions and innovative care models to improve care for complex, costly and vulnerable populations.
David Smith, Medicaid Transformation Project executive at Avia, describes four challenges areas — behavioral health, substance use disorder, women and infant care and avoidable emergency department visits — as “things that continue to vex all of us,” explaining the project “wants to take these categories and decompartmentalize to seek out solutions.”
Smith highlights a “digital solution” as “technology that can be brought to bear in improving or enhancing a core function.” The participating health systems including 280 hospitals.
As Smith explains it, hospital systems traditionally have come together for collaborative purchasing, accountable care ventures and to influence policy. He describes the Medicaid project as being distinct in bringing systems together “to identify unique solutions — care models and technology — to more efficiently render care to vulnerable individuals where they are.”
However, Jeff Myers, president and CEO of Medicaid Health Plans of America, says “to do Medicaid transformation is more than cool ideas….I’m not sure what ‘secret sauce’ they have that isn’t being explored already.”
Myers notes there are “serious people” behind the project, which acquires “serious heft” from the participation of major health systems. “It is not clear to me, however, that a lot of integrated health systems behind it understand what’s necessary to fully manage the health of the populations they take full risk for in an effective way,” he says.
Some see the project’s potential. “This effort is important because hospitals represent the largest category of Medicaid acute care spend and, in particular, health system-based outpatient services are one of the fastest areas of Medicaid growth,” says Sandeep Wadhwa, M.D., chief health officer at Solera Health.