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Where tech-enabled Medicaid innovation is sorely needed

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From L to R: North Carolina HHS Secretary Mandy K. Cohen, CareMore CEO Sachin Jain and Blue Shield Promise Health Plan CEO Greg Buchert

In the overwhelming rush that makes up the J.P. Morgan Healthcare Conference, there’s often precious little time devoted to innovation in Medicaid.

That was part of the impetus behind the creation of the Future of Medicaid Innovation Forum put on by HealthTech4Medicaid, a recently launched advocacy group made up of venture-backed companies looking to develop innovative solutions for the Medicaid population.

Instead of the exhibition hall of a large hotel, the event took place in Glide Memorial Church in San Francisco a Methodist church known for its nonprofit social programs and advocacy.

“How can we encourage these entrepreneurs? How can we help them to move faster?” said HealthTech4Medicaid founder and ConsejoSano CEO Abner Mason in his welcome speech. “What we believe is that just because people are low income they shouldn’t have to wait 10 years for solutions that will benefit their health today.”

Significant structural challenges remain in pushing forward better technologies for Medicaid patients. Reimbursement levels are comparatively lower and the roughly 75 million Medicaid beneficiaries are split between states which individually administer their own unique programs.

As part of an effort to better target innovation on high need problems across the range of Medicaid programs that dot the country, common priorities gleaned from a roundtable series sponsored by the California Health Care Foundation Health Innovation Fund were presented.

According to the research, the top shared priorities for Medicaid programs were member engagement, data exchange, data actionability and workforce capacity.

Tech solutions to those problems stakeholders were seeking included better mining of publically available data, assisting members in navigating available resources, real-time or automated referral management tools, dynamic resource mapping and better e-consult tools to augment the skills of the existing workforce.

A fireside chat featured Mandy Cohen, Secretary of Health and Human Services at State of North Carolina and Sachin Jain, the CEO of integrated health system CareMore Health provided perspectives on how their organizations were tackling some of the significant social barriers for the Medicaid patient population.

“We’re trying to really focus on the whole person so that is physical health, mental health and unmet social need,” said Cohen, who is helping to lead North Carolina’s large-scale transition to a managed Medicaid system.

“Tech innovators need to think about what’s really driving health and clearly those factors are food, housing, transportation, violence and jobs.”

One example she gave was a partnership with startup Unite Us to better connect patients with existing community resources. The state has also recently received a first-of-its-kind waiver from CMS allowing up to $650 million in Medicaid spend to be directed at pilot programs providing services like healthier food and bridge housing.

CareMore started out in the high-cost Medicare space, but has expanded into the high-cost Medicaid population. Jain said the organization has developed a model of care that will expand to six states by the end of the year focused on direct outreach into community to bring in high-need patients.

“Technology plays a role in not only identifying those populations but communicating and building continual relationships with them,” Jain said.

He also highlighted what he called “radical common sense,” solutions which may seem simple, but have an outsized effect on health outcomes. For example, installing a ramp to avoid a fall, rather than prescribing medication after the fall happens.

“Those are the things that will make a far bigger difference than where the majority of people are focusing their energy,” Jain said.

When it comes to selling into Medicaid plans, Jain gave this piece of advice to digital health entrepreneurs: Aspire for empathy and think holistically about how the technology will be actually implemented.

“I meet with a lots of vendors and providers of technology solutions who are only thinking about their one problem and their one solution,” Jain said. “The reality is implementing any one of your solutions takes extraordinary effort and you have to work through procurement, IT and finance and actually measure its effectiveness.”

Picture: Kevin Truong, MedCity News

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