MHPA x Scene Webinar | From Fragmentation to Integration: Leveraging Linkage to Care & Public Health Strategies to Bridge the Gaps in Medicaid

Watch the full webinar recording:

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Panelists

• Rachel Bauch, Director of Virtual Health Strategy & Partnerships at UnitedHealthcare 
• Mikal Sutton, Managing Director, Medicaid Policy Blue Cross Blue Shield Association
• Dr. Christine Burrows, Vice Chair, Clinical Ambulatory Ops and Population Health at the University of Cincinnati
• Dr. Ryan Van Ramshorst, Chief Medical Director for Medicaid/CHIP Services at Texas Health and Human Services Commission
• Dr. Bob Bollinger, Raj and Kamla Gupta Professor of Infectious Diseases at the Johns Hopkins University School of Medicine*
• Sebastian Seiguer, Scene Health CEO

Top five takeaways from the discussion

Innovative approaches are improving healthcare delivery and reducing fragmentation in Medicaid, but challenges remain. In this Medicaid Health Plans of America (MHPA) panel discussion, a diverse group of health plan leaders and experts came together to discuss solutions. Here are the top insights from their conversation.

1. Dr. Bob Bollinger highlighted the value of the Cascade of Care framework and the Linkage to Care approach. 

“In a patient journey, there are multiple steps, and in each one of these steps, there are specific barriers for patients, and it can vary from patient to patient and population to population. Not every step that's required is incentivized. That's part of what the challenge is when we talk about fragmentation and how to integrate the approach. Ideally, you want to shift to a story where you overcome the barriers at each step by increasing access through Linkage to Care. Linkage to Care provides linkage to support services to overcome the barriers causing this drop-off in the cascade of care.” — Dr. Bob Bollinger, Raj and Kamla Gupta Professor of Infectious Diseases at the Johns Hopkins University School of Medicine.‍

2. Rachel Bauch explained how technology is a social determinant of health and shared UnitedHealthcare’s efforts to bridge the digital divide.

“One approach is the establishment of our telehealth hubs or access points. These hubs are in private spaces within community-based organizations that feel safe and familiar to our members. They're equipped with high-speed internet and devices that members can use to connect to their virtual care provider or digital health solution…We're also thinking about deploying tablets and devices to members' homes or community-based organizations. So in Louisiana today, we have tablets deployed to a number of CBOs within that market.” — Rachel Bauch, Director of Virtual Health Strategy & Partnerships at UnitedHealthcare.‍

3. Sebastian Seiguer and Mikal Sutton explored the impact of asynchronous technology in meeting patients where they are, with Sutton providing insights into North Carolina’s NC Care 360 program. 

“We don't learn everything we need to know in a single office visit, or even a single telemedicine visit, but having the asynchronous ability for people to share issues and concerns with us at the time that is convenient for them. I think it's gonna really strengthen our ability to optimize their linkage to these support services.” — Sebastian Seiguer, Co-Founder and CEO, Scene Health

“One example is the Care 360 program, part of the Healthy Opportunities Initiative in North Carolina. It's a statewide coordinated care network that electronically connects those with identified health-related social needs with community sources and then allows for that feedback loop on the outcomes of that connection.” — Mikal Sutton, Managing Director, Medicaid Policy Blue Cross Blue Shield Association‍

4. Rachel Bauch, Mikal Sutton, and Dr. Ryan Van Ramhorst critically examined the challenges posed by reimbursement limitations.

“There's a lot of restrictions state by state on asynchronous modalities of care or audio only…When we're looking at states that are not reimbursing for it, essentially what that's doing is that we can't meet our members where they are on their own time because we're not able to use asynchronous technology…So, to overcome some of those barriers, we're actively advocating to state and federal regulators to expand reimbursement. We partnered with the American Telemedicine Association last week and had a huge win. The House Ways and Means Committee passed the ‘Preserving Telehealth, Hospital, and Ambulance Access Act’ that extends all the telehealth flexibilities for the next two years for Medicare, but we see that having implications for our Medicaid plans since they typically kind of follow suit.” — Rachel Bauch, Director of Virtual Health Strategy & Partnerships at UnitedHealthcare.

“Medicaid dollars have to be used for medical services. And so when you're introducing non-medical services like those wraparound SDOH services for housing, food, transportation, outside of what's in the medical benefit, it's not paid for. So, as of right now, when plans do implement those programs just to improve those outcomes, it's all out of their bottom dollar. It's all out of their administrative dollars. And again, that can stifle or have a chilling effect.” — Mikal Sutton, Managing Director, Medicaid Policy Blue Cross Blue Shield Association

“One of the ways that Texas has sought to address this issue is we allow our MCOs to count costs associated with non-medical drivers as quality improvement costs, which is different than as an administrative cost. It's not to say that the money is in the capitation rate, but it doesn't negatively impact their medical loss ratio to help remove that disincentive if you will.

And really it's our health plans that help to identify this.” — Ryan Van Ramhorst, Chief Medical Director for Medicaid/CHIP Services at Texas Health and Human Services Commission‍

5. Dr. Christine Burrows explored the negative implications of value-based care metrics for providers serving vulnerable populations.

“Moving towards value-based care and metrics is great. However, the metrics fall on primary care, which oftentimes have the least resources…And when I look at practices in our system, our practice that serves largely inner-city patients with complex medical conditions and lots of social drivers, we have learning collaborators, we have outreach, we have tons of work we do to get to 63% hypertension control. But our neighboring practice in our health system, which is in a very wealthy neighborhood, is at 82%, and they do nothing in terms of any quality, so they get paid more money.” — Dr. Christine M. Burrows, Vice Chair, Clinical Ambulatory Ops and Population Health at the University of Cincinnati

Conclusion

The insightful discussion highlighted the importance of technological solutions that disseminate SDOH resources through the Linkage to Care approach to address fragmentation in Medicaid, with a wealth of real-world examples shared by the panelists. However, the discussion also emphasized that despite significant progress, addressing reimbursement limitations and ensuring equitable resource allocation remain critical challenges. Thanks to the panelists who joined us and shared their insights!

* Disclosure: 𝘛𝘩𝘦 𝘑𝘰𝘩𝘯𝘴 𝘏𝘰𝘱𝘬𝘪𝘯𝘴 𝘜𝘯𝘪𝘷𝘦𝘳𝘴𝘪𝘵𝘺 𝘩𝘢𝘴 𝘢 𝘧𝘪𝘯𝘢𝘯𝘤𝘪𝘢𝘭 𝘪𝘯𝘵𝘦𝘳𝘦𝘴𝘵 𝘪𝘯 [𝘚𝘤𝘦𝘯𝘦] (𝘧𝘰𝘳𝘮𝘦𝘳𝘭𝘺 𝘦𝘮𝘰𝘤𝘩𝘢), 𝘢 𝘵𝘦𝘤𝘩𝘯𝘰𝘭𝘰𝘨𝘺 𝘵𝘩𝘢𝘵 𝘸𝘢𝘴 𝘪𝘯𝘷𝘦𝘯𝘵𝘦𝘥 𝘢𝘵 the 𝘑𝘰𝘩𝘯𝘴 𝘏𝘰𝘱𝘬𝘪𝘯𝘴 𝘜𝘯𝘪𝘷𝘦𝘳𝘴𝘪𝘵𝘺. 𝘛𝘩𝘪𝘴 𝘧𝘪𝘯𝘢𝘯𝘤𝘪𝘢𝘭 𝘪𝘯𝘵𝘦𝘳𝘦𝘴𝘵 𝘪𝘯𝘤𝘭𝘶𝘥𝘦𝘴 𝘦𝘲𝘶𝘪𝘵𝘺 𝘪𝘯 𝘵𝘩𝘦 𝘤𝘰𝘮𝘱𝘢𝘯𝘺 𝘢𝘯𝘥 𝘦𝘯𝘵𝘪𝘵𝘭𝘦𝘮𝘦𝘯𝘵 𝘵𝘰 𝘳𝘰𝘺𝘢𝘭𝘵𝘪𝘦𝘴. 𝘋𝘳. 𝘉𝘰𝘭𝘭𝘪𝘯𝘨𝘦𝘳 𝘪𝘴 𝘢𝘯 𝘪𝘯𝘷𝘦𝘯𝘵𝘰𝘳 𝘰𝘧 𝘵𝘩𝘦 𝘵𝘦𝘤𝘩𝘯𝘰𝘭𝘰𝘨𝘺, 𝘢𝘯𝘥 𝘩𝘦 𝘩𝘢𝘴 𝘦𝘲𝘶𝘪𝘵𝘺 𝘢𝘯𝘥 𝘢 𝘳𝘰𝘺𝘢𝘭𝘵𝘺 𝘪𝘯𝘵𝘦𝘳𝘦𝘴𝘵 𝘪𝘯 [𝘚𝘤𝘦𝘯𝘦]. 𝘏𝘦 𝘪𝘴 𝘢 𝘮𝘦𝘮𝘣𝘦𝘳 𝘰𝘧 𝘵𝘩𝘦 [𝘚𝘤𝘦𝘯𝘦] 𝘣𝘰𝘢𝘳𝘥 𝘰𝘧 𝘥𝘪𝘳𝘦𝘤𝘵𝘰𝘳𝘴 𝘢𝘯𝘥 𝘪𝘴 𝘢 𝘤𝘰𝘯𝘴𝘶𝘭𝘵𝘢𝘯𝘵 𝘵𝘰 𝘵𝘩𝘦 𝘤𝘰𝘮𝘱𝘢𝘯𝘺. 𝘛𝘩𝘦𝘴𝘦 𝘤𝘰𝘯𝘧𝘭𝘪𝘤𝘵𝘴 𝘰𝘧 𝘪𝘯𝘵𝘦𝘳𝘦𝘴𝘵 𝘢𝘳𝘦 𝘣𝘦𝘪𝘯𝘨 𝘮𝘢𝘯𝘢𝘨𝘦𝘥 𝘣𝘺 𝘵𝘩𝘦 𝘜𝘯𝘪𝘷𝘦𝘳𝘴𝘪𝘵𝘺 𝘪𝘯 𝘢𝘤𝘤𝘰𝘳𝘥𝘢𝘯𝘤𝘦 𝘸𝘪𝘵𝘩 𝘪𝘵𝘴 𝘤𝘰𝘯𝘧𝘭𝘪𝘤𝘵-𝘰𝘧-𝘪𝘯𝘵𝘦𝘳𝘦𝘴𝘵 𝘱𝘰𝘭𝘪𝘤𝘪𝘦𝘴.