Transforming Medicaid: How Andy Slavitt, AVIA and 28 Health Systems Plan to Improve Care for Underserved Patients

May 29, 2019
The Medicaid Transformation Project now has 28 health systems in 25 states on board, and its leaders are quickly moving to close gaps in the way the current system cares for Medicaid patients

Even though his time as chief of Medicare and Medicaid came to an end in January 2017 with the change in administrations, Andy Slavitt’s passion to transform the nation’s healthcare system has never waned. In fact, since he left his post as Acting Administrator of the Centers for Medicare & Medicaid Services (CMS) in January 2017, that dedication might have only amplified.

Slavitt helped launch the “United States of Care” health reform group early in 2018, with the broad goal of putting healthcare over politics. A few months later, he announced the creation of a venture capital firm, called Town Hall Ventures, that invests in healthcare technology and service companies transforming care delivery to the country’s most vulnerable populations. Slavitt’s third endeavor in this area was the launch of the Medicaid Transformation Project (MTP)—co-led by the former CMS head and AVIA, a Chicago-based digital health innovation network—an initiative that will look to pinpoint, develop and scale digital solutions to assist Medicaid patients.

For Slavitt, the commitment to reshape Medicaid did not expire when he left CMS; moreover, being in the private sector now affords him the ability to pull levers that weren’t possible when he was a government official. “As I left CMS, I really started to focus on the work that needs to be done today so that 10 years from now, people living in this country have a healthcare system that meets the needs of all Americans from all walks of life. That has been my commitment,” Slavitt expressed in a recent interview with Healthcare Innovation.

Indeed, the Medicaid Transformation Project, which launched last August with 17 health systems in 21 states, has now expanded its reach to 28 health systems covering more than 350 hospitals in 25 states that are devoted to addressing the unmet needs for nearly 75 million Americans who rely on Medicaid. The five health systems that currently anchor the project are Advocate Aurora Health, Baylor Scott & White Health, Dignity Health, Geisinger and Providence St. Joseph Health.

“We need to change the way we invest in communities that are underserved,” Slavitt says, further attesting that the current healthcare system primarily focuses on and invests in commercial populations—"quite frankly, white, middle- and upper-class populations of people that are already pretty healthy and have very few issues accessing the healthcare system.”

How MTP Leaders Envision the Future 

According to project leaders, throughout the next two years, participating health systems will be implementing innovative solutions aimed at addressing several critical challenges facing vulnerable populations across the country, with a focus on four core target areas—behavioral health, women and infant care, substance use disorder, and avoidable emergency department visits.

While Slavitt and others involved in the MTP fully acknowledge that across U.S. healthcare, many patient care organizations already are working on projects to better address the needs of their Medicaid communities, the problem is that these endeavors are often unknown to others. “There is always something good going on somewhere in healthcare, but the frustrating fact becomes when you cannot replicate those good things, when the knowledge isn’t shared, and when we don’t bring the power of large amounts of talent, energy, capability and capacity to try to scale those things,” says Slavitt.

He brings up the financial services industry as an example of a sector in which innovation scalability works differently from healthcare. “If someone creates a new feature such as taking a photograph of your check and using that [image] to instantly deposit the check, within a very short amount of time, every bank will have that service. There is quick adoption,” he says. “But in healthcare, if someone figures out a novel way to care for someone in a community, none of us have any confidence that it will forcefully transform the healthcare system. So, we have to do things differently,” Slavitt contends.

Also importantly, MTP leaders do not believe that its participants need to reinvent the wheel—or invent anything at all. Rather, if one organization has had success with a certain project—say getting nutritious food to people, or has an innovative way of doing emergency transportation—the core goal is to share those experiences and lessons learned with the other health systems. “It’s not as if we are trying to do something proprietary. Quite to the contrary; these 28 systems aren’t [engaging] in this project to create a competitive advantage, but rather to create a better model, to test a better model, to get results from a better model, and to prove that out and share it more broadly,” Slavitt says.

Rigorous Work at the Ground Level

David Smith, Medicaid Transformation Project executive at AVIA, says that for each of the challenge areas the MTP is focusing on, arduous work is required to determine which solutions are appropriate for which problems, and how they can be deployed as strategically useful.

For each problem area, MTP leaders will examine what the evidence says about the digitally-enabled care models that have been introduced, and if they have been effective or not. Then, explains Smith, the barriers to these care models and care delivery performance are outlined, with the last element being to examine which capabilities are needed to break those barriers down. Those identified capabilities are brought to the market to see if solutions have been developed, and if they have, MTP leaders set out to narrow down the ones they think are best.

And that process of narrowing down the digital solutions is rigorous itself. First, notes Smith, project leaders conduct a cursory review to see if that digital solutions company has participated in Medicaid in a meaningful way and if it has proof points. Then, the tool itself is analyzed by examining the sophistication of its user interface and product roadmap. Next, there is an RFI that goes out to some subset of the finalists to get deeper into elements such as the capital structure, strategic partners, and technology and security parameters. From there, a final list of solutions that project leaders think their participating health systems will benefit from is produced.  

The initial focus in Phase 1 of the MTP’s work centered on improving linkages from the ED to other critical parts of the delivery system, namely primary care, behavioral health, specialty care, and social services and supports. So, for this challenge area, community health workers, community reform network platforms, non-emergency medical transportation solutions, and triage and treatment solutions were all evaluated, says Smith.  For the behavioral health target area, he notes that 150 initial solutions were dwindled down to just 11. The work for the women and infant care and substance use disorder challenge areas have either just begun or will begin later this year, Smith adds.

What’s more, when a best practice or solution has been leveraged successfully by a health system, a web-exclusive presentation is given by that implementing organization inclusive of how it made an ROI decision as well as going over the successes and failures of that project. Action forums are also held, with the idea to bring the community together and drive market learning, Smith says.

Patient Care Leaders Bear the Responsibility 

Slavitt believes that it’s essential for health system leaders to first understand the medical burdens of their respective communities by looking closely at available data. “What the MTP allows you to do is ask the question, what are the 27 other healthcare systems doing about this problem? I guarantee you there are no unique challenges. There might be unique manifestations of that challenge and unique circumstances in the community, but not unique challenges,” he says.

The next step is for patient care leaders to spend time figuring out how they plan to make these efforts a significant priority, Slavitt offers. “As I talk to each of the CEOs who are involved, they [need to know] that it doesn’t make sense to get involved unless they are willing to make this one of the three most important initiatives across the board,” he says. And that entails getting the CFO involved, he adds. “People complain that Medicaid reimbursement rates are so low, and they are low, but one of the important points I try to make is that one way to make more money is to lose less money. So if you have fewer Medicaid recipients who are in your hospital because you kept them healthy and have taken care of them in the community, you can free up those beds for commercial patients.”

In the end, the responsibility forwhich solution to specifically deploy falls on the health systems themselves. “Each health system has to decide what’s right for them,” says Slavitt. My challenge to [health system leaders] is to have to adopt several new things and test them. Pick the ones that are right for you,” he adds.

“Slavitt emphasizes that his work involves an economic imperative in that patient care leaders are investing in their health of their populations. “Most of the health systems I talk to say they don’t mind spending money, or even losing money on lower income populations, as long as they feel as if they are investing it in someone’s health,” he says. “And in the process, they learn how to do population health management.”

Both Slavitt and Smith have ambitious goals for the MTP across the next 10 years, starting with studying if systems are adopting solutions rapidly, while measuring which ones get adopted and have experienced success, as well as which ones have not.

Down the road, the bigger picture is to take the impactful solutions and best practices that can be replicated and scaled, and describe that to policymakers and to associations that can drive it to their safety net hospitals, federally qualified health centers (FHQCs), and health plans, explains Smith. “We want to drive the learnings that we [believe] will demonstrably improve care in a community through every channel we can,” he says.