Foothold recently attended the HMA Conference highlighting critical challenges and innovations in the healthcare sector, particularly focusing on Medicaid. Many of these key points were salient to the NY 1115 waiver. Here’s a breakdown of the key points:
The Medicaid of Things:
Foothold observed that healthcare is confronting complex challenges, extending beyond traditional medical care to encompass issues such as food insecurity, housing, and the impacts of climate change on health. Medicaid is increasingly being recognized as the “Medicaid of things,” signifying its expanded role in addressing a diverse array of health-related issues influenced by social determinants. This shift, while crucial for overall population health, poses financial challenges for Medicaid as it navigates upstream.
Enrollment Trends:
Anticipating a 20% increase in Medicaid and Medicare enrollments over the next five years, Foothold notes a notable shift in the healthcare landscape toward public insurance programs. As Medicaid faces growing pressures, the need for innovation becomes imperative to effectively handle the evolving challenges posed by increased demand and changing demographics.
Innovations in Medicaid:
Public health programs like Medicaid are typically not seen as innovators. That is a key role they play and will continue to do moving forward. Public health programs have to solve the complicated problems that private payers don’t always address. A current example of this is addressing the Mental Health crisis. Another example is in New York, where a revised 1115 waiver is working to solve health equity issues. This trend is attributed to Medicaid’s pivotal role as a primary driver of healthcare accessibility, pushing for creative solutions to cater to the diverse needs of its beneficiaries.
Factors Leading to Innovations:
– Role of State Budgets: Acknowledging the crucial role of state budgets in shaping healthcare policies, Foothold emphasizes the necessity for innovations to be budget-neutral. Balancing improved healthcare services with fiscal responsibility remains a key challenge.
– Waivers: Foothold recognizes state waivers as a vital tool providing flexibility for experimentation. This allows states to test novel approaches, services, or payment models within the Medicaid framework, fostering an environment conducive to innovation. The New York State 1115 waiver is a good example of weaving in Community Based Organizations (CBOs) as part of the healthcare fabric.
– Nature of Medicaid: The inherent nature of Medicaid, designed to serve diverse populations, adds complexity to the need for innovative solutions. Unlike private insurance, Medicaid lacks the selective luxury, requiring tailored approaches to address the multifaceted health issues faced by its beneficiaries.
Data-Driven Solutions:
Another key trend emerging from the conference was the need to be data driven as part of communicating among health care players. Payers, hospital systems, and other public health experts recognize that one of the biggest learnings from the COVID-19 pandemic was the need to leverage the connections that CBOs have to people to address health issues. Health care experts understand that there are several factors on why people may not engage through traditional health channels: Lack of trust, navigating the complexity, the ability to access health care to name a few factors. CBOs have the connection and trust in the communities they serve and can break down the barriers to health care for all people. There is a flip side to the conversation. CBOs also must be able to capture data and share data with other stakeholders so that they can fully enter into the public health care partnership. Using and providing data-driven solutions will offer human service organizations a more prominent seat at the table with regard to health care conversations.
Collaborative Approach and Data Alignment:
Recognizing the need for a collaborative approach to tackle complex healthcare problems, data provides the foundation to have the conversations to address the problems. Data solutions must begin with data alignment. This is often the hardest part of the conversation and the most necessary. Being able to align on what data is needed, when it is needed, how it is exchanged can set up collaboratives to truly address unique and challenging issues. Data alignment provides a common ground for stakeholders to work from, which can foster the use of data to unlock innovative solutions.
A great example of collaborating on data was highlighted at the conference when experts from California were talking about working with individuals who were incarcerated and were going to be released. Many of the CBOs had wonderful plans and options for those individuals, but it was challenging to implement because there wasn’t clarity and coordination around the release dates and those dates could be fluid. As the stakeholders gathered and aligned on specific data points like release date, new and better options to serve the population evolved quickly.
These conversations from the HMA conference underscore the evolving role of Medicaid in addressing complex health challenges and the imperative for data-driven, collaborative innovations to offer solutions to those challenges. Involving CBOs as part of the public health conversation will be vital for any innovation to effectively work. The delicate balance between improved services and fiscal responsibility remains a central theme in the pursuit of effective and sustainable healthcare solutions.