Medicaid has traditionally remained a decade behind the rest of the healthcare system when it comes to the adoption and implementation of new technology.

The labyrinthine and fragmented programs – and lower reimbursement rates – have acted as a major barrier to the introduction of the kinds of solutions that could play a significant role in improving patient outcomes.

However, alongside those challenges exists enormous need and opportunity, especially when considering the fact that Medicaid helps to cover around 75 million people.

In response to this disconnect, VC firm Village Capital, the nonprofit California Health Care Foundation and healthcare consultancy Speire Healthcare launched a roundtable series called Primed to engage stakeholders from across the healthcare value chain to understand the common tools and priorities across various Medicaid program necessary to drive better innovative practices.

Primed hed a series of statewide roundtables in Massachusetts, Tennessee, Colorado and Washington, D.C. to bring Medicaid officials, entrepreneurs, payers and investors to hone in on shared problems and potential scalable solutions.

The four shared challenges identified by the program were member engagement, data actionability, data exchange and workforce capacity.

When we work with companies as they try scale in California and beyond, it’s apparent that they can’t build their solutions to only work in one state,” Melissa Buckley, the director of the CHCF Health Innovation Fund.

“We talk a lot about how different we are all in terms of regulation and policies, and while that’s true, the bigger picture is that we are all struggling with the same things and learning similar lessons.”

In terms of member engagement, for example, Medicaid programs face the perennial program of reaching and staying in touch with members who are transient and are often equipped to navigate the healthcare system with their benefits.

One common thread in potential solutions is using communication methods that work well with the Medicaid population like mobile devices. A 2018 study from Deloitte found that 86 percent of adult Medicaid beneficiaries own a mobile phone, equivalent to the general U.S. population.

Making transportation, care delivery and educational opportunities available through that channel could be an easily scalable avenue to improve Medicaid member engagement.

“If you look at texting or telehealth there’s no reason that those resources should only be available to high income populations,” Buckley said. “If something has proven with scientific rigor then that should be reimbursement in Medicaid as there is in Medicare.”

As more and more health data is created and collected many Medicaid providers face the challenge of data actionability. In other words pulling useful information outside of the reams of numbers.

Primed identified a market need for platforms that are able to cut through some of the noisy data and aggregate knowledge in way that is both useful for clinicians and personalized to the Medicaid population. That could mean integrating other sources of non-health information to help identify gaps in care and barriers to accessibility.

Related to the problem of data actionability is the issue of data exchange to overcome the cultural and technological barriers to interoperability. There’s a growing recognition of the role social determinants play in overall health, but also a lack of widespread tools that are able to bring together the social and clinical sides of the healthcare equation.

Technology companies can play a role in aggregating this information in a useful manner that can help providers think more holistically in the way they are delivering care by engaging not only front-line clinicians, but also community health workers, social workers and other members of the care team.

The last common challenge highlighted by Primed was workforce capacity, which means the use of technology as a way to bolster existing resources and staffers. That can include both optimizing the skills of the existing workforce, as well as equipping non clinicians with tools to provide evidence-based care.

“We would rarely say you should start in Medicaid, it’s an incredibly complex evenement to build the bolts and nuts of your business but, once you have that done people should be thinking about Medicaid because of volume,” Buckley said. “It also makes your product stronger, more flexible and gives you the ability to build out evidence in a different population.”

Among the advice that Medicaid providers and officials gave to technology vendors looking to enter the space was to come from a place of collaboration and not domination. That means helping to tailor solutions to work in existing workflows and understanding the larger situation and challenges faced by potential Medicaid customers.

Overall, Buckley said the roundtables also helped to crystalize issues of common alignment when it comes to policy and regulatory changes like the institution of collaborative care codes that allow primary care models to function more holistically and take on more behavioral health components.

Another example is working on reimbursement for tech-enabled care delivery in Medicaid like telehealth products an e-consults, which is necessary to expand access to care for patients.

Photo: zimmytws, Getty Images



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