Today the Medicaid program covers one in five Americans, nearly 75 million individuals. CVS Health Chief Policy and External Affairs Officer and General Counsel Tom Moriarty shared this statistic in his opening remarks at the June 2017 POLITICO Pro Health Care Briefing on Medicaid as a Driver of Care Innovation in the States. Despite the uncertainty about the future of health care in the United States, he said, “the one thing that will remain constant is the need to deliver more value to patients and taxpayers by improving quality and lowering costs.”
The event brought together experts from across the health care industry to expand on the discussion that began at the POLITICO working group, which focused on state Medicaid innovations and the future of the Medicaid program.
The panel noted that some of the most innovative examples of driving value in the health care delivery system are found at the state and local levels, thanks to their relative flexibility to conceive and implement new approaches. As a result, looking at innovations within the Medicaid program can provide insights on key issues, such as improving outcomes while reducing costs, and adapting to changes in financing models while still optimizing access to care.
Lowering Costs Through Innovative Health Care Delivery and Payment Models
Panelists agreed that some of the most exciting innovations in care delivery across the nation are those working to address social determinants of health, which include factors such as community support resources, housing, transportation and job opportunities. For example, Medicaid programs in Texas, Maryland, California and elsewhere have been engaging in partnerships with social services organizations to address key factors that impact the health of Medicaid beneficiaries and that have the potential to achieve better outcomes and reduce hospital readmissions.
The panelists noted the importance of aligning priorities among tangential agencies in order to advance progress, as well as the value of managed care and integrated care models in helping to improve the delivery of needed services for Medicaid beneficiaries; these models help address patient health needs in a comprehensive fashion while reducing costs in the long term.
To illustrate this point, they highlighted coordinated care organizations in a number of states, including the integrated behavioral and physical health model in Arizona, as examples of how managed care has been able to save millions of dollars while better addressing patient’s primary care, behavioral health and long-term care needs.
Leveraging Flexibility in the Midst of Potential Financing Changes
While several examples showcased the ability for innovation to deliver value, some experts noted that potential financing changes could limit future experimentation with new health care delivery and payment models.
For example, panelists acknowledged that Medicaid is often on the front lines of addressing emerging public health issues, such as the Zika virus or the Flint water crisis. In addition, the introduction of breakthrough medicines at extremely high prices can be hard to account for under more restrictive financing models. On the other hand, panelists added, the states’ flexibility can be an opportunity to structure their programs in a way that helps overcome financial pressures.
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