Medicaid is a powerful program and an indispensable resource for over 50 million Americans.
It’s also a political football, a challenging service model for health care providers and patients alike, and an institution whose structural challenges (like state-by-state inconsistencies) and decades-old blind spots (like limited programs focused on social determinants of health) keep it from realizing its full potential.
Here are five things we as a society could do to make Medicaid serve society better, as well as insight into how close we are to making them happen.
Debunk Medicaid Stigmas
It’s an oversimplification to say that Medicaid covers only 20 percent of Americans. Arguably, every other American is born under Medicaid coverage, since nearly 50 percent of all live births are financed by the program. Yet many still dismiss or denounce Medicaid as a program that is only relevant for a small group of people.
Providence St. Joseph Health has a model for reducing these stigmas and correcting the misperceptions about Medicaid recipients: the Many Faces of Medicaid campaign. This digital outreach effort profiles the real-life stories of Medicaid recipients across the demographic spectrum. It demonstrates that Medicaid recipients don’t fit any one profile. They are adult Americans with low incomes, and they are children. They are Americans with disabilities, many of whom earn middle class incomes that would be wiped out by paying the full cost of the services necessary for managing their conditions. They are elderly people who are eligible for Medicare and need extra help, or who depend on Medicaid for long-term care.
Moving Medicaid recipients out of the margins of popular perception could help reduce the mistaken notion that cuts in Medicaid spending are net positives for society. Slashed benefits compel people to delay care until they’re seriously ill — but by that time care can be extremely costly and less productive. The result is more debt, more personal bankruptcy, and worse health outcomes.
“There’s no avoiding a cost burden,” said Aaron Martin, executive vice president and chief digital and innovation officer at Providence St. Joseph Health. “But there are ways of making it smaller by getting ahead of it” — through prevention, for example.
Improve Data Analytics To Inform Providers And Streamline Complex Services
Those involved in the fabric of Medicaid patient care and delivery can do more with the data they already have.
Consider the growth and success of dedicated diabetes education. The data-driven decision to hire diabetes educators in populations with large, high-risk patient segments has had a proven positive impact.
“If I looked at 100 Medicaid patient records and the only information I saw was the list of medications each was on, that would give me tremendous predictive value about who is going to end up back in the hospital,” said Rod Hochman, M.D., president and CEO of Providence St. Joseph Health. “We need to look at those high-risk patients and find more ways to intervene.”
One key opportunity is in promoting healthy, full-term births. According to Ohio Department of Health statistics, full-term babies generate just one-tenth of the first-year health care costs of preterm infants. Using data analysis to focus efforts to upgrade housing conditions for pregnant women (by prioritizing lead, mold and pest remediation programs, for example); to address tobacco and drug use among them; and to improve their nutrition could help.
And these messages and support tools can be delivered digitally and in-context — in communities, not just in clinics.
Focus On Social Determinants Of Health
Studies show the dramatic impact that social factors have on health, with strong correlations for higher life expectancy and lower infant mortality rates among wealthier and better-educated individuals. Overlooking the role Medicaid can play in recognizing and improving these factors is a mistake.
“If you’re concerned about housing, transportation or having sufficient food, it’s hard to take care of your high blood pressure or diabetes,” explained Karen Boudreau, M.D., senior vice president of enterprise care management and coordination at Providence St. Joseph Health. “You have other more pressing needs to take care of.”
Medicaid-backed life coach programs are cropping up as an alternative to more costly clinical interventions. Lower-cost coaches “make sure your patients take their pills and have something to eat and somewhere to sleep,” Hochman — who oversaw a similar program in Virginia — pointed out. “These are not high-tech innovations, but the health effect is dramatic and it has great pull in reducing costs.”
Overcome Barriers To Access
Accepting Medicaid patients in-clinic is not the same as providing convenient access. For many in the Medicaid population, just getting to a scheduled appointment in a consistent and timely manner can be a challenge. Many have jobs that do not provide paid time off. Sole or primary parents and caregivers face substantial limits on their time and mobility. Transportation is a core Medicaid benefit, but one in need of a serious digital overhaul.
“Most states have really arcane systems, unreliable transportation providers, old-school enrollment, or some combination,” Boudreau observed.
Developing a new class of digital apps that apply ride-sharing service concepts to the Medicaid sphere could help. By linking available transport with up-to-the-minute data on available clinicians, we can ensure door-to-door access for patients, even when their plans change. Without this flexibility, too many turn instead to the ER. There, care delivery is much more costly — and fills beds that could be used for more acute concerns.
“When the hospital is on the bus line and they have pressing needs to take care of, using the ER is almost always rational, from that person’s perspective,” said Boudreau. “We have to figure out how to make it as convenient, satisfying and high-quality to get care in other ways.”
Growing acceptance of telehealth services across a variety of different clinical needs, from behavioral health to low-acuity needs for the diagnosis and treatment of colds and the flu, also helps. “We’re introducing tele-psychology and tele-neurology services and finding that individuals love them,” Hochman said. “It gives patients privacy and portability when we can offer care right on their screens.”
Embrace Digital Engagement
Federal and state programs like Lifeline aim at ensuring consistent and affordable access to essential personal technology. All Medicaid recipients are eligible for the Lifeline service, which provides a subsidized (often free) smartphone and service plan to low-income Americans. This means that a very high concentration of Medicaid members have the same digital technology as individuals who use private-pay options. Virgin Mobile’s Assurance Wireless is another such service, providing Android-based phones to subscribers. This is relevant to the health care industry, because many Medicaid recipients find it much more convenient to connect digitally with their providers.
“The Medicaid population is more likely to have a smartphone than a landline — and some are even more likely to have a smartphone than a stable mailing address,” said Rhonda Medows, M.D., executive vice president and chief population health officer at Providence St. Joseph Health. “Being digital and web-based is really important.”
Medows recommends three apps to any healthcare provider looking for digital inspiration:
· Circle: A parenting app developed by the Providence St. Joseph’s Digital team that covers everything from prenatal care to the teen years with content, relevant products and services, and connection to providers.
· Caring Village: An app designed to relieve the burdens on caregivers while improving care quality for their loved ones.
· Xealth: A tool enabling healthcare teams to “prescribe” digital tools, services and educational content to patients.
Medicaid patients look like America. And, like other Americans, most already carry the tools for better health in their pockets. It’s time for providers to embrace opportunities to innovate beyond the obstacles.
