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Medicaid Innovation: Improving Access to Care Through Virtual Health

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I recently participated at Adaptation Health’s first demo day for Medicaid innovation, Responding to COVID-19 and Beyond

Part one of a three part series connecting Medicaid leaders with health innovators, this session focused on expanding access to maternity and behavioral care through virtual solutions for vulnerable populations. 

Leading the session was a panel of experts presenting the challenges and barriers to improving access to care for Medicaid beneficiaries, including Andrey Ostrovsky of Social Innovation Ventures and former Chief Medical Officer of Medicaid; James Schuster, VP of Behavioral Integration and the Chief Medical Officer for Behavioral, Medicaid and Special Needs Services at UPMC and Jared Augenstein, Director at Manatt, Phelps & Phillips, LLP.

The panel discussion left me with several key takeaways:

New reimbursement pathways are critical to delivering care.

● COVID-19 has left many Medicaid-reimbursed businesses in dire financial straits, with many only surviving because of altruistic and compassionate investors.

● Recent funding packages have largely neglected safety-net organizations, which lack the funding to buy necessary software/hardware for virtual solutions.

Access to care is not always the problem.

● Engaging patients in preventative care, and ongoing management versus acute service, is a primary challenge to the use of virtual solutions.

● Support from community services is crucial to engage patients in preventative care. 

● Language barriers prevent many non-English speakers from using virtual solutions, typically available only in English.

Policy changes are necessary to make telehealth as effective as it could be for Medicaid.

● The current patchwork of policy across states complicates the ability of companies to provide services to Medicaid. 

● The flexibility granted to CMS because of the health crisis can only be sustained through new legislation.

● FQHCs and RHCs should be considered as distance sites for telehealth (similar to rural areas), to allow for reimbursement. 

COVID-19 will have long-term effects on the healthcare landscape.

● State budgets will be more constrained over the next 2 to 3 years, and the recent rise in unemployment means a sharp uptick in people eligible for Medicaid: telehealth can play a role in continuity of care.

● The use of virtual care will likely be more common than before COVID-19, but not as prevalent as during the pandemic, as temporary reimbursement measures go out of effect. 

A balance of virtual and in-person visits is the ideal system for care delivery, but structural changes must occur to implement it successfully.

● There must be a move away from fee-for-service (FFS) and toward globally capitated risk. FFS leads to more backlog, increased morbidity as practices forego appointments due to lack of reimbursement.  

● Funding  for increased mobile data for patients could increase growth for telehealth platforms and increase access through closing the digital divide.

In sum, there’s a critical need for companies that can integrate both virtual and in-person care. It’s these companies that are poised for success in the current climate, but whether policy on reimbursement will keep up with the need for innovation remains to be seen.

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