When Andy Slavitt ran the Medicaid program for nearly two years under the Obama administration, he observed limited progress to scale up digital technology to improve care for vulnerable, low-income patient populations.
“The healthcare system moves too slowly in adopting innovation,” Slavitt told FierceHealthcare, noting that health systems often roll out pilot projects focused on improving behavioral health, for example, but these programs aren’t scaling up to really move the needle.
The former acting CMS administrator is seeking to drive a national effort to address the issues of Medicaid—such as accelerating the adoption of digital health technologies with an eye toward social determinants—that he couldn't when he was in charge.
Slavitt, who has started a venture capital firm that invests in digital health technology, teamed up with healthcare innovation network AVIA to lead 28 health systems to collaborate, share best practices and more rapidly adopt digital health solutions and digitally enabled care models with a targeted focus on four key issues facing Medicaid patients: behavioral health, women and infant care, substance use disorder and avoidable emergency department visits.
Five health systems currently anchor the project: Advocate Aurora Health, Baylor Scott & White Health, Dignity Health, Geisinger and Providence St. Joseph Health.
Called the Medicaid Transformation Project, the initiative kicked off last summer with 17 health system members and has added 11 more systems. The 28 health systems comprise more than 350 hospitals in 25 states.
The idea is that these organizations can collaborate nationally and act locally to drive change, project leaders said.
“Part of the problem with healthcare and why it doesn’t change is that everyone is focused on what they can do this year and this budget cycle, but they need to think in much longer terms. We believe it’s going to take a decade for us to see the kind of transformation that we think we need to see,” he said.
Immediate work to support long-term goals
During the Obama administration, CMS took a number of steps to address social determinants and population health, such as the Comprehensive Primary Care Initiative, which established a medical home model, as well as a focus on accountable care organizations (ACOs). Studies indicated the CPC showed improvements in primary care delivery, but the program did not save CMS money overall. Current HHS Administrator Alex Azar has called previous efforts in the CMS ACO program "lackluster."
Under the Trump administration, CMS officials are trying to move the needle with recent changes to expand Medicare Advantage benefits to include food and transportation to doctor's appointments. The Trump administration also is allowing state Medicaid programs to test new models of integrated care to treat dual-eligible beneficiaries.
HHS also is pushing the industry to advance interoperability and give patients easier access to their health data to improve care coordination.
Despite these efforts, there continue to be significant gaps in care, Slavitt said. The Medicaid Transformation Project is tackling the first of four challenge areas—enhancing community care and reducing unnecessary ED visits.
During a leadership forum in October, participating health system leaders discussed care models that had shown success—but had been previously limited by barriers in labor, cost, or technology. They viewed 10 on-site demonstrations of scalable solutions and relevant care models, ranging from community health worker programs to virtual triage, according to David Smith, project executive at AVIA.
“Although there is not a lot of evidence-based literature that supports, just yet, the quality and cost impact on deploying these solutions, there’s a tremendous amount of work happening with companies like Uber and Lyft trying to use digital technology to better anticipate patients’ needs or meet patients where they are,” he said.
The participating health systems are honing in on a single challenge area: improving behavioral health resources in underserved communities. As of 2016, 44.7 million American adults—including 10 million adults covered by Medicaid—experienced a mental health illness. Beyond issues of care, there are cost challenges as well. Spending on Medicaid beneficiaries with mental health needs is nearly four times greater than for peer beneficiaries.
Executives at AVIA researched and analyzed more than 150 digital solutions in the behavioral health space and created a shortlist of 11 solutions and best practices.
During a recent forum in April, participating health system leaders evaluated the 11 solutions, identified which tools met their organizations’ needs and will now begin to roll them out. The tools and best practices target things like integrating behavioral health and primary care and using data to identify high-risk patients.
This approach helps to accelerate decision making and adoption of digital health tools, Smith said, as AVIA narrows down the list based on the capabilities that health system leaders say they are looking for.
Policy tailwinds also offer an additional springboard for health systems looking to take on mental health challenges with expanded incentives for behavioral health integration, new collaborative care, and solutions focused on addictions.
"I challenged the health system leaders: pick the three things you like the best and adopt those. You’re not going to get your mental health program in your community to perfection in the next 12 months. That’s not the goal; the goal is to make it better," Slavitt said.
He added, "If two of those things work then we can figure out what are the conditions that make it work the best."
The bigger picture
Last year, Slavitt founded Town Hall Ventures, a venture capital firm, and he said one key goal of this overall initiative is to spur digital health investment in the Medicaid space. “One sign of success is if people see that this is a vibrant place for innovation,” he said. It is unclear if the initiative is tied to his investment work.
Later this year, health systems will begin work on the next two challenges areas: women and infant care and substance use disorder. Over the next three years, project leaders expect to see broad adoption and solution uptake, followed by scaling up those initiatives and measuring results and then sharing best practices, Smith said.
Slavitt said one way he plans to gauge the project's progress is by evaluating the level of engagement by health systems. "Are they digging in? How many solutions have they adopted? The level of interest and work so far has been high."
Another way to measure success will be individual patient stories, Slavitt said. “I challenge organizations to tell me a story about someone who came to the ER, someone on suicide risk, or a veteran with PTSD (post-traumatic stress disorder), and tell me how their life has changed in the course of what you’ve done over the past 12 months. With those stories, we’ll be able to push the organizations toward further progress,” he said.