Seventeen health systems in 21 states, comprising 280 hospitals, and a number of other healthcare industry stakeholders, are collaborating on an ambitious, long-term project to identify, develop, and scale financially sustainable digital solutions that improve the health of underserved individuals and families in their communities.
With five leading health systems anchoring the work, among them San Francisco-based Dignity Health and Danville, Pa.-based Geisinger Health System, the Medicaid Transformation Project, which was announced August 28, will focus on pinpointing, developing and scaling digital solutions to assist Medicaid patients.
The 17 heath systems involved in this project currently serve 43 million Medicaid enrollees, or 58 percent of the 75 million total Medicaid enrollees across the U.S. The project is being co-led by Chicago-based AVIA, which leads a network of health systems focused on digital innovation and transformation, and former CMS Acting Administrator Andy Slavitt, who also founded Town Hall Ventures, a venture capital firm devoted to investing in and supporting entrepreneurs who are improving the health of underserved populations.
“The current healthcare system fails the people who need it most,” Slavitt said in a press release announcing the project’s launch. “The Medicaid Transformation Project will be part of a decade-long journey leading some of the best health systems in the country. Our work will be to deepen and refine the best innovations and then implement them at an accelerated pace at providers across the country.”
According to project leaders, in the next two years, participating health systems will begin implementing innovative solutions aimed at addressing several critical challenges facing vulnerable populations across the country—behavioral health, women and infant care, substance use disorder, and avoidable emergency department visits. The overarching work of the project will span 10 years, Slavitt says. “It’s going to take a decade to have the kind of impact to transform care delivery the way we want to,” he says.
Linda Finkel, president of AVIA, says project leaders have bold, ambitious goals for the initiative. “We have great aspirations. We’re looking for nothing short of actually moving the needle on the health and healthcare of the 75 million Medicaid beneficiaries in the country today,” she says. “While we’re focused on health system-led innovation, we won’t be satisfied unless we find that we have both moved the needle on the financial sustainability of meeting the health and healthcare needs of these populations and have actually improved their health.”
The five health systems anchoring the work are Advocate Aurora Health in Chicago and Wisconsin; Baylor Scott & White Health in Dallas; Dignity Health in San Francisco; Geisinger in Danville, Pa.; and Providence St. Joseph Health in Renton, Wash. In addition to those five health systems, the other 12 health systems involved in the Medicaid Transformation Project are Allina Health (Minneapolis, Minn.); Ballad Health (Johnson City, Tenn.); Christiana Care Health System (Wilmington, Del.); Froedtert & the Medical College of Wisconsin (Milwaukee); Henry Ford Health System (Detroit); Memorial Hermann Health System (Houston); Navicent Health (Macon, Ga.); OSF HealthCare (Peoria, Ill.); Presbyterian Healthcare Services (Albuquerque, N.M.); Rush University Medical Center (Chicago); Spectrum Health (Grand Rapids, Mich.); and UVA Health System (Charlottesville, Va.).
Currently, one in five Americans is covered by Medicaid and 50 percent of U.S. births are financed by Medicaid. Medicaid is the country’s No. 1 payer for behavioral health services, and 33 cents of every dollar for a physician’s services are paid by Medicare/Medicaid, according to project leaders. In a statement about the scope of the Medicaid Transformation Project’s work, Geisinger CEO and President David Feinberg said, “The gap between the needs of vulnerable populations and the healthcare they receive is too great. We are no longer interested in discussing the problems our patients are facing or just piloting solutions – we’re interested in solving them as quickly as possible.”
Slavitt, who served as acting administrator for CMS under the Obama Administration, says improving healthcare for underserved populations will take a collaborative, collective approach. “This is a challenge that is best not approached individually hospital by hospital with everyone doing just their own best work. We have a national challenge in that we have very significant health inequities in this country, based upon people’s zip code, their income level, their race, ethnicity, gender and language and socioeconomic status; these are challenges that we should all be investing in as a country.” And, he adds, “It’s also a call for innovators, for digital companies, for tech companies, for venture capitalists and private equity companies, to say, if we create real solutions, we now know there are at least 17 major health systems that are very interested in evaluating them and rolling them out.”
Finkel notes that many of the health systems involved in the Medicaid Transformation Project also are members of the AVIA Innovator Network and have had a “running start” on tackling these complex challenges. “We have been working with our health systems for a number of years to help them leverage digital to meet the needs of vulnerable populations. It became evident to us that there was an opportunity that was fairly unprecedented to take the systems in our network, who are committed to meeting the needs of these populations but need to do it in a financially sustainable way, and leverage the work we do and power that up, via digital.”
Froedtert Health has been a member of the AVIA Innovator Network for three years, with a focus on adopting technology solutions to address areas such as post-acute care and behavioral health. Michael Anderes, chief innovation and digital officer at Froedtert Health, says this new collaboration among 17 health systems has the potential to better address the needs of vulnerable communities through the proliferation and adoption of shared digital solutions and innovative care models.
“If we tackle some of these things together, we can obviously learn from each other but also accelerate some of the work, because we are not all individually trying to assess these various models and different technologies,” he says. By working together, health systems can identify and implement solutions offered by early-stage technology companies and startups at a faster pace with lower risk, he notes.
However, technology solutions alone are not a silver bullet to solve complex problems with care delivery to vulnerable populations. “With this particular work, there is going to be a heavy dose of care model redesign, which is something that we really want to share best practices across this network because none of us have solved this,” Anderes says.
From Collaboration to Action
As part of the initital work on this initiative, the Medicaid Transformation Project will assemble a core team at each health system to implement solutions. Health system leaders will share best practices across the network, creating a roadmap for partner organizations to act quickly to create change, the project leaders say. The work will feature a leadership council, chaired by Slavitt and composed of health system CEOs.
According to Slavitt, health system leadership will meet quarterly to collectively discuss the challenges and share best practices. “This is what AVIA does quite well, they will help get all the ingredients necessary for innovation to be successful and to take off. That includes doing an assessment of what health systems are doing well, what the gaps are, what the business case is for filling those gaps and a scan of what the best technology and innovation companies are doing to fill those gaps,” he says, adding, “AVIA’s role is to help to get those things disseminated and adopted, as well as things that aren’t best practices yet but outside-in solutions.”
The collaboration and sharing of best practices among the health systems could entail technology adoption or process changes, or both, Anderes says. “Our experience to date has been no matter what technology we’ve worked with and whatever problem we’re trying to solve, it’s always tied back to a relatively significant operational change. In this case, it will be hard to know whether the technology will drive the operational change, or the operational change will enable the technology, but I can’t envision any of this work being just a technology in isolation,” he says.
Finkel also notes that the scope of this work is broader than just the Medicaid population. “There is a recognition that [Medicaid] is a wildly underserved segment of the marketplace. There has been a disproportionate investment in meeting the needs of commercial and Medicare patients and very little directed at Medicaid,” she says. “That said, we do believe, while Medicaid is the rallying cry for this work, we know that the solutions and care models that systems will roll out will impact more than just Medicaid patients. There will be considerable spillover across other patient populations, including commercial and Medicare. But for us, the Medicaid-first approach that we see solution companies taking into the marketplace, that gives us a roster of capabilities to pull from that just never existed.”
The announcement of the Medicaid Transformation Project comes at a time when senior healthcare officials in the Trump Administration are working to reshape Medicaid. Back in January, the Centers for Medicare & Medicaid Services (CMS) issued a memo confirming that it will accept state Medicaid waivers that include work requirements as a condition for eligibility. Opponents say these policies would take coverage away from those who need it most. The Trump administration has already approved work requirements on certain Medicaid populations in Indiana, Arkansas, Kentucky and New Hampshire. Slavitt has been an outspoken critic of the Trump Administration’s approach to reforming Medicare and Medicaid.
Back in June, House Republicans also released a proposal that would balance the budget in nine years, and the proposal includes $1.5 trillion in cuts to Medicare and Medicaid.
David Smith, formerly of Leavitt Partners, will guide the Medicaid Transformation Project and has partnered with a number of leading Medicaid experts as active participants in the work. “There is an incredible confluence of market and policy activity creating the right conditions to drive profound change for the least fortunate among us. Our health system partners believe that this moment is unique and their leadership can have a seminal impact in catalyzing nationwide energy and focus on the challenges facing our communities,” he said in a statement.
Finkel contends that transforming healthcare delivery to vulnerable populations is a “bipartisan problem” that requires “bipartisan solutions.” “Our systems have really concluded that they can’t wait around for Washington anymore, it doesn’t matter who is in office. They understand that this is work that needs to happen now,” she says.
Many industry stakeholders, including Slavitt, whose Town Hall Ventures focuses on care for the underserved, seem bullish on the idea of the private sector disrupting Medicaid and transforming health care for the underserved. In fact, digital health startups are increasingly focused on building digital tools and services specifically to help vulnerable populations. "I personally think that the most exciting place in healthcare, by far, is going to be these kinds of things, caring for vulnerable populations," Slavitt says.
Finkel contends that digital technology innovation is the key to transforming U.S. healthcare. “The simple fact of the matter is that [digital] is the last remaining lever to do that. The systems in our network have squeezed every ounce of juice out of process improvement and capital expansion, and you can only conclude that digital remains the critical opportunity to take these pockets of success and actually scale them in replicable ways,” she says.
Healthcare is the last remaining industry not to see the full benefits of technology, Finkel contends. “Health systems are notoriously risk-adverse and rightfully so, they treat patients. Our aspiration is to take the risk out of acting, on behalf of really moving the needle in our communities and in the health systems with who we work," she says.