Dive Brief:
-
Former CMS Administrator Andy Slavitt is helping lead the Medicaid Transformation Project, a new effort involving AVIA and 17 healthcare systems that include 280 hospitals.
-
The project participants will identify, develop and scale financially sustainable programs for Medicaid recipients that address health outcomes and social determinants of health.
-
They will focus on key challenges for Medicaid, including behavioral health, women and infant care, substance use disorder and avoidable emergency department visits.
Dive Insight:
More and more insurers (and providers) are looking to social factors as a way to approach making improvements in overall health. A person's ZIP code is often a key determinant of their health status.
CMS has made efforts to key in on social determinants of health in the Medicare program. Under a recent rule change, payers offering Medicare Advantage plans, which are growing in popularity, can include benefits that improve housing stability, food security and transportation to medical appointments.
And Medicaid, like Medicare, is a major target for reducing costs. Spending for Medicaid increased nearly 4% in 2016 to $565.5 billion, or 17% of total national health expenditure. Total spending for the program is expected to reach nearly $1 trillion by 2026, according to CMS.
The new Medicaid partnership includes big names in healthcare. Advocate Aurora Health in the Midwest, Dignity Health on the West Coast and Geisinger on the East Coast are all taking part. There are 17 systems involved across 21 states, representing about 5% of the nation's hospitals.
In announcing the initiative, the project leaders pointed to statistics that showcase Medicaid's increased influence on healthcare and costs. Medicaid covers about 20% of Americans, finances 50% of U.S. births and is the No. 1 payer for behavioral health services.
In a prepared statement, Dignity Health CEO Lloyd Dean said healthcare systems need consumer-centric solutions that engage patients in personalized medicine. By doing so, they can reduce healthcare costs for vulnerable patients, he noted.
"It is my hope that our collaboration will unleash new avenues that bring down barriers to care and improve the overall health of our communities," Dean said.
Slavitt, a former Obama administration official who founded venture capital firm Town Hall Ventures, said the healthcare system "fails the people who need it most." The new project will be a "decades-long journey" to improve healthcare, he added.
"Our work will be to deepen and refine the best innovations and then implement them at an accelerated pace at providers across the country," Slavitt said.
The team expects to share best practices and create a plan to implement successful programs quickly. The project will rely heavily on digital solutions and technologies to focus on health disparities.
Medicaid expansion has transformed the federal-state program from one that focuses on those in dire financial straits to one that cares for the poor and the lower-middle class. This announcement comes a day after CMS Administrator Seema Verma at a Senate hearing called Medicaid "an open-ended entitlement" rather than a safety-net program as originally envisioned. The Trump administration wants to "reset the balance" of the program, which includes providing more flexibility to states, stronger accountability and enhanced program integrity, she said.
Trump administration efforts have included granting waivers to help states reduce their Medicaid rolls, including work requirements. However, a federal judge already kicked back Kentucky's work requirements and CMS is seeking more comment on the idea.
The Medicaid Transformation Project wants to find ways to reduce costs and improve care, but it's coming at it from a much different direction than CMS is currently. During the Obama administration, Slavitt saw Medicaid grow as many states expanded enrollment under the Affordable Care Act. In fact, Medicaid expansion added most of the newly insured from the past several years.
Rather than look for avenues to reduce the size of the Medicaid program, the project is hoping to find ways to address social determinants of health, reduce costs, improve care and serve as a scalable blueprint for health systems.