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| December 4, 2018

Together top U.S. healthcare CEOs advance innovation for Medicaid programs

Anca Spanu

Anca's career in journalism spans over 2 decades. She has served as staff writer, editor and deputy chief editor at... Anca's career in journalism spans over 2 decades. She has served as staff writer, editor and deputy chief editor at various media outlets all over the world. At Healthcare Weekly, Anca writes about current events, innovations in the healthcare space and events/ conferences with a focus on investing & startups.

HealthTech4Medicaid (HT4M), a national nonprofit organization seeking to revolutionize the healthcare system by bringing technology innovation to Medicaid, announced its organizational launch November 13th.

What does HT4M want to do, exactly?

Increasing quality and eased access to healthcare are the main two directions of HT4M’s vision for the healthcare system. Both these wishes could be fulfilled by pushing innovation forward.

Medicaid innovation, according to HT4M, is the creation and use of technology to increase patient access, reduce costs, and drive better health outcomes in Medicaid programs. This has to be combined with an appropriate evolution of legislation and policy fit to enable greater innovation and use of health technology in the Medicaid program.

Why innovate? Well, the answer is really easy: innovation means better treatments, less time spent in hospitals, and healthier people who can take better care of themselves.  All these accomplishments equal less money needed in the system, money which could go to further innovation and research.

There are a number of ways to achieve such results. Precision medicine with targeted individualized treatments, and AI powered drugs delivered directly to the affected organs via miniature medical devices, AI technology which helps patients deal with symptoms of chronic illnesses at home, with less medical assistance and less hospital time, and better recovery after surgery, due to new, improved medical devices, are only a few examples.   

Collaboration in learning and discovering seems to be the key

The idea is to provide better care solutions to Medicaid recipients, by encouraging collaboration to find the best solutions at a rapid pace. The organization is a mission-based market enabler that facilitates cross-sectoral, collaborative partnerships in health technology nationwide.

More than forty top healthtech CEOs from across the country are members.  They receive advice from an Expert Council comprising some of the most accomplished and experienced names in healthcare.

“Medicaid recipients and traditionally disadvantaged populations are often overlooked by new technology,” said Leah Sparks, Co-Chair of HT4M and CEO of Wildflower Health. “Our goal is to use technology innovation to reimagine how these patients are served.”

How will these partnerships work? Basically HT4M wants to bring together venture-backed entrepreneurs, payers and providers, by providing them with educational programming, resources, and tools meant to bring all these factors together and make them work towards mutual goals.

“Our members and Advisory Council bring a broad range of expertise, resources and innovation to HT4M,” said Abner Mason, Founder and Co-Chair of HT4M and CEO of ConsejoSano. “We’re thrilled to bring the group together to drive real change in technology innovation for Medicaid.”

Who are the CEOs planning to change the face of healthcare?

HT4M CEO members include Abner Mason, ConsejoSano; Adam Kaufman, Canary Health; Andrew Le, Buoy Health; Andrey Ostrovsky, Concerted Care; Anjali Kataria, Mytonomy; Arun Gupta, Quartet; Bing Doh, HealthCrowd; Brenda Schmidt, Solera Health; Chris Nicholson, mPulse Mobile; David van Sickle, Propeller Health; Emily Chen, MediQuire; Eric Heil, BehaveCare; Erine Grey, Aunt Bertha; Gil Addo, RubiconMD; Glen Tullman, Livongo; Heskey Kutscher, CareDox; Ikenna Okezie, Somatus; Iyah Romm, Cityblock Health; Jacob Luria, Algorex Health; Jamo Rubin, TAVHealth; Jason Langheier, Zipongo; Jessica Harthcock, Utilize Health; Jini Kim, Nuna; Josh Golomb, Hazel Health; Juan Pablo Segura, Babyscripts; Justin Dangel, Ready Responders; Leah Sparks, Wildflower Health; Manik Bhat, Healthify; Matthew Loper, Wellth; Matt Sopcich, myStrength; Mindi Knebel, Kaizen Health; Pedram Afshar, Sage Health; Raymond Figueroa, Blue Cloud Pediatric Surgery Centers; Richard Hassett, Integra ServiceConnect; Russ Johannesson, Glooko; Sean Duffy, Omada Health; Si France, Welbe Health; Stephanie Tilenius, Vida Health; Tim Petrikin, Ampersand Health; Trip Hofer, AbelTo and Wolf Shlagman, CareAngel.

Advisory Council members are Castulo de la Rocha, AltaMed; Christian Seale, StartupBootcamp Miami; Claudia Williams, Manifest MedEx; Cristal Gary, Leavitt Partners; David Smith, AVIA; Francis Rienzo, Medicaid Health Plans of America; Greg Buchert, MD, Blue Shield of California’s Care1st Health Plan; Jay Rosen, Health Management Associates; Jon Kaplan, Boston Consulting Group; Mark B. McClellan, MD,  Robert J. Margolis Center at Duke University; Melissa Buckley, CHCF Health Innovation Fund; Molly Coye, MD, Executive in Residence at AVIA; Patrick Conway, MD, Blue Cross Blue Shield of North Carolina; Richard Bookman, UHealth Care Lab; Rich Roth, Dignity Health; Rishi Manchanda, MD, HealthBegins; Urmimala Sarkar, MD, UCSF and SOLVE Health Tech.

Why is this venture so important?

Medicaid covered patients became so numerous, that healthcare executives realized that any solution that works for these, can be successfully applied to patients covered by other, more expensive, types of medical insurance. In other words, what works for the less rich, could always work for the richer, but not the other way around, obviously.  

Why is it so important to find new solutions for Medicaid enrolled patients? The answer is in the numbers.

Since its creation in 1965, Medicaid grew to become the largest source of medical and health-related services for U.S. Americans with a low income and limited resources.

Resources used for the program, which is funded by both federal and state governments, are also very significant.

Medicaid’s share of total U.S. health care spending amounted to 17 percent in 2017. Medicaid spending has increased over the last ten years, as the percentage of people enrolled in  Medicaid has also been growing.

The numbers explain why healthcare CEOs are interested in finding new solutions for Medicaid covered patients. According to the statistics from September 2018, 72,966,179 individuals were enrolled in Medicaid and CHIP in the 51 states reporting. 66,421,583 individuals were enrolled in Medicaid and 6,544,596 individuals were enrolled in CHIP.

Compared to the period before the first Medicaid open enrollment period (July – Sept. 2013), more than 15.3 million additional individuals were enrolled in Medicaid and CHIP in September 2018, in the 49 states that reported relevant data for both periods, which equals an increase of more than a 27.1 percent  over the baseline period.

How big are the Medicaid expenditures?

California has the highest Medicaid spending of all U.S. states, followed by New York, Texas, and Pennsylvania. Expressed as a percentage of overall US costs,  Medicaid’s expenditure is especially significant in the area of personal and residential care, since Medicaid hospital costs make up almost one fifth of total U.S. hospital costs.

In 2017, Medicaid expenditures were near 600 billion U.S. dollars for the first time, with the federal share some 150 billion dollars higher than the state funds.

Medicaid’s role within U.S. health care became even more significant since the Patient Protection and Affordable Care Act was introduced. From 2014, the federal health care law implemented a substantial increase in Medicaid eligibility, which prompted Medicaid enrollment to begin growing with that year. Medicaid expenditure projections anticipated a similar trend, with spending almost doubled between 2014 and 2024. However, recent efforts to repeal Obamacare make the future development of Medicaid expansion somewhat difficult to foresee.   


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