State Medicaid programs are natural innovators, experts say—but they also worry about looming cuts

WASHINGTON, D.C.—State Medicaid programs—and the managed care insurers that work with them—are major drivers of innovation in the healthcare system, panelists said Tuesday at a Politico Pro event.

Yet some of those experts were also worried that even with the Trump administration’s support for flexibility and waivers, its planned cuts to Medicaid could hamper states’ ability to continue innovating  with tactics from screening for social determinants of health to the use of technology.

“We are really concerned it’s a death spiral for Medicaid managed care,” Meg Murray, the CEO of the Association for Community Affiliated Plans, said about the possibility of switching Medicaid funding to a per capita cap or block grant arrangement.

Trish Riley, executive director of the National Academy for State Health Policy, echoed that sentiment, saying, “I don’t think you can innovate your way out of cuts this big.”

Regardless of what transpires at the federal level, though, the experts agreed that state Medicaid programs can learn from each other’s creative approaches to addressing some of healthcare’s most pressing challenges.

To Thomas Barker, partner and co-chair of Foley Hoag LLP’s healthcare practice, it’s “fascinating” how states have been able to take a decades-old program like Medicaid and figure out a way to adapt it to 21^st-century medicine.

“It’s not easy, but it’s amazing to me how states have been able to do it,” he said.

Bruce Siegel, M.D., president and CEO of America’s Essential Hospitals, noted that there’s “great work” being done at the state level to tackle social determinants of health. In San Francisco, for example, patients are being screened for these factors in clinical settings.

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Managed care plans are also leading the way, according to Murray. CalOptima, she noted, help set up a respite facility to provide a place to stay for homeless individuals who are discharged from the hospital, which helped reduce readmissions. CareSource, meanwhile, has been giving food packets to diabetic patients to help keep them healthy, while the New York plan Amida Care has done “incredible work” with job training to help people become patient navigators, she said.

Managed care plans are also leveraging technology. Nearly all of her organization’s member plans use telemedicine, which Murray said is particularly helpful for helping fill behavioral health care gaps in areas like child psychiatry. Some plans even give personal care attendants iPads to help them record patients' condition when they conduct home-based visits, then give that information to care coordinators or primary care physicians.

Christopher Koller, president of the Milbank Memorial Fund, noted that Medicaid programs are also making strides toward integrating physical and behavioral care in the primary care setting. States are also “looking down the barrel of a gun” with the aging population poised to enter high-priced nursing homes, which will require them to get even more creative with long-term services and supports, he said.

As for policy changes that could further facilitate those efforts, Siegel said he would like to see an expedited approval process for state waivers, while Murray said she hoped to see demonstrations for dual-eligible beneficiaries continue. For his part, Koller just wants to see greater coordination at the federal level.

The key, Koller said, is simply to “make sure these agencies are talking to one another.”