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:
โ
Panelists
- Rachel Bauch, Director of Virtual Health Strategy & Partnerships at UnitedHealthcareย
- 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.ย
โIn 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.โ โ Dr. Bob Bollinger, Raj and Kamla Gupta Professor of Infectious Diseases at the Johns Hopkins University School of Medicine.โ
2. Rachel Bauch explained how technology is a social determinant of health and shared UnitedHealthcareโs efforts to bridge the digital divide.
โOne 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 solutionโฆWe'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.โ โ Rachel Bauch, Director of Virtual Health Strategy & Partnerships at UnitedHealthcare.โ
3. Sebastian Seiguer and Mikal Sutton explored the impact of asynchronous technology in meeting patients where they are, with Sutton providing insights into North Carolinaโs NC Care 360 program.ย
โWe 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.โ โ Sebastian Seiguer, Co-Founder and CEO, Scene Health
โOne 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.โ โ Mikal Sutton, Managing Director, Medicaid Policy Blue Cross Blue Shield Associationโ
4. Rachel Bauch, Mikal Sutton, and Dr. Ryan Van Ramhorst critically examined the challenges posed by reimbursement limitations.
โThere's a lot of restrictions state by state on asynchronous modalities of care or audio onlyโฆWhen 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 technologyโฆSo, 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 โPreserving Telehealth, Hospital, and Ambulance Access Actโ 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.โ โ Rachel Bauch, Director of Virtual Health Strategy & Partnerships at UnitedHealthcare.
โMedicaid 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.โ โ Mikal Sutton, Managing Director, Medicaid Policy Blue Cross Blue Shield Association
โOne 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.โ โ Ryan Van Ramhorst, Chief Medical Director for Medicaid/CHIP Services at Texas Health and Human Services Commissionโ
5. Dr. Christine Burrows explored the negative implications of value-based care metrics for providers serving vulnerable populations.
โMoving towards value-based care and metrics is great. However, the metrics fall on primary care, which oftentimes have the least resourcesโฆAnd 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.โ โ 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: ๐๐ฉ๐ฆ ๐๐ฐ๐ฉ๐ฏ๐ด ๐๐ฐ๐ฑ๐ฌ๐ช๐ฏ๐ด ๐๐ฏ๐ช๐ท๐ฆ๐ณ๐ด๐ช๐ต๐บ ๐ฉ๐ข๐ด ๐ข ๐ง๐ช๐ฏ๐ข๐ฏ๐ค๐ช๐ข๐ญ ๐ช๐ฏ๐ต๐ฆ๐ณ๐ฆ๐ด๐ต ๐ช๐ฏ [๐๐ค๐ฆ๐ฏ๐ฆ] (๐ง๐ฐ๐ณ๐ฎ๐ฆ๐ณ๐ญ๐บ ๐ฆ๐ฎ๐ฐ๐ค๐ฉ๐ข), ๐ข ๐ต๐ฆ๐ค๐ฉ๐ฏ๐ฐ๐ญ๐ฐ๐จ๐บ ๐ต๐ฉ๐ข๐ต ๐ธ๐ข๐ด ๐ช๐ฏ๐ท๐ฆ๐ฏ๐ต๐ฆ๐ฅ ๐ข๐ต the ๐๐ฐ๐ฉ๐ฏ๐ด ๐๐ฐ๐ฑ๐ฌ๐ช๐ฏ๐ด ๐๐ฏ๐ช๐ท๐ฆ๐ณ๐ด๐ช๐ต๐บ. ๐๐ฉ๐ช๐ด ๐ง๐ช๐ฏ๐ข๐ฏ๐ค๐ช๐ข๐ญ ๐ช๐ฏ๐ต๐ฆ๐ณ๐ฆ๐ด๐ต ๐ช๐ฏ๐ค๐ญ๐ถ๐ฅ๐ฆ๐ด ๐ฆ๐ฒ๐ถ๐ช๐ต๐บ ๐ช๐ฏ ๐ต๐ฉ๐ฆ ๐ค๐ฐ๐ฎ๐ฑ๐ข๐ฏ๐บ ๐ข๐ฏ๐ฅ ๐ฆ๐ฏ๐ต๐ช๐ต๐ญ๐ฆ๐ฎ๐ฆ๐ฏ๐ต ๐ต๐ฐ ๐ณ๐ฐ๐บ๐ข๐ญ๐ต๐ช๐ฆ๐ด. ๐๐ณ. ๐๐ฐ๐ญ๐ญ๐ช๐ฏ๐จ๐ฆ๐ณ ๐ช๐ด ๐ข๐ฏ ๐ช๐ฏ๐ท๐ฆ๐ฏ๐ต๐ฐ๐ณ ๐ฐ๐ง ๐ต๐ฉ๐ฆ ๐ต๐ฆ๐ค๐ฉ๐ฏ๐ฐ๐ญ๐ฐ๐จ๐บ, ๐ข๐ฏ๐ฅ ๐ฉ๐ฆ ๐ฉ๐ข๐ด ๐ฆ๐ฒ๐ถ๐ช๐ต๐บ ๐ข๐ฏ๐ฅ ๐ข ๐ณ๐ฐ๐บ๐ข๐ญ๐ต๐บ ๐ช๐ฏ๐ต๐ฆ๐ณ๐ฆ๐ด๐ต ๐ช๐ฏ [๐๐ค๐ฆ๐ฏ๐ฆ]. ๐๐ฆ ๐ช๐ด ๐ข ๐ฎ๐ฆ๐ฎ๐ฃ๐ฆ๐ณ ๐ฐ๐ง ๐ต๐ฉ๐ฆ [๐๐ค๐ฆ๐ฏ๐ฆ] ๐ฃ๐ฐ๐ข๐ณ๐ฅ ๐ฐ๐ง ๐ฅ๐ช๐ณ๐ฆ๐ค๐ต๐ฐ๐ณ๐ด ๐ข๐ฏ๐ฅ ๐ช๐ด ๐ข ๐ค๐ฐ๐ฏ๐ด๐ถ๐ญ๐ต๐ข๐ฏ๐ต ๐ต๐ฐ ๐ต๐ฉ๐ฆ ๐ค๐ฐ๐ฎ๐ฑ๐ข๐ฏ๐บ. ๐๐ฉ๐ฆ๐ด๐ฆ ๐ค๐ฐ๐ฏ๐ง๐ญ๐ช๐ค๐ต๐ด ๐ฐ๐ง ๐ช๐ฏ๐ต๐ฆ๐ณ๐ฆ๐ด๐ต ๐ข๐ณ๐ฆ ๐ฃ๐ฆ๐ช๐ฏ๐จ ๐ฎ๐ข๐ฏ๐ข๐จ๐ฆ๐ฅ ๐ฃ๐บ ๐ต๐ฉ๐ฆ ๐๐ฏ๐ช๐ท๐ฆ๐ณ๐ด๐ช๐ต๐บ ๐ช๐ฏ ๐ข๐ค๐ค๐ฐ๐ณ๐ฅ๐ข๐ฏ๐ค๐ฆ ๐ธ๐ช๐ต๐ฉ ๐ช๐ต๐ด ๐ค๐ฐ๐ฏ๐ง๐ญ๐ช๐ค๐ต-๐ฐ๐ง-๐ช๐ฏ๐ต๐ฆ๐ณ๐ฆ๐ด๐ต ๐ฑ๐ฐ๐ญ๐ช๐ค๐ช๐ฆ๐ด.
Speakers
Rachel Bauch
Director of Virtual Health Strategy and Partnerships, UnitedHealthcare
Dr. Bob Bollinger
Raj and Kamla Gupta Professor of Infectious Diseases, Johns Hopkins University School of Medicine
Dr. Christine Burrows
Vice Chair, Clinical Ambulatory Ops and Population Health, University of Cincinnati
Dr. Ryan Van Ramhorst
Chief Medical Director for Medicaid/CHIP Services, Texas Health and Human Services Commission
Sebastian Seiguer, JD, MBA
Chief Executive Officer & Co-Founder, Scene Health
Mikal Sutton
Managing Director, Medicaid Policy, Blue Cross Blue Shield Association