How 17 Health Systems Aim to Transform Medicaid by Partnering With Peers, Entrepreneurs

Stakeholders want underserved communities to have the same cutting-edge technology, entrepreneurialism and problem-solving focus that is used by top health systems.

The 17 health systems collaborating in the newly created Medicaid Transformation Project say they want to close the gap between the needs of vulnerable populations and the healthcare they receive.

The collaborative, which includes 280 hospitals in 21 states, will focus on several problem areas for underserved communities, including behavioral health, women and infant care, substance use disorder, and avoidable emergency department visits.

Related: 17 Health Systems Form Medicaid Transformation Project

Rich Roth, chief strategic innovation officer at San Francisco-based Dignity Health, one of the "anchor" health systems in the collaborative, spoke with HealthLeaders about the project and what the health systems hope to accomplish. The following is a lightly edited transcript.

HLM: Why is the Medicaid Transformation Project Needed?

Roth: There needs to be an injection of the next level of innovation and entrepreneurialism for all communities, including those people who are most vulnerable. There has been a lot of innovation, but sometimes it's innovation for a certain segment of the population but not for everyone. It is incumbent upon us to drive that innovation for all communities, all individuals, regardless of their payer status.

HLM: Can you provide an example of how this transformation would work?

Roth: At Dignity Health, for example, we have strong expertise in digital transformation; using novel care models and digital methods to care for all populations. Other systems have expertise in different things. This is a chance for us to get around the table and help drive transformation based upon our shared accomplishments in unique areas and help to create things that may only work in one state or service area now, and that need fuel to help them scale nationally to accomplish the goals of benefitting all individuals.

That could be through solutions individual systems have created. It could be through an entrepreneurial company, or it could be finding needs at the table for these forward-leaning systems that say "we need a solution in this area" and co-creating something to address problems that are not effectively being addressed.

HLM: One of the project's focus areas is avoidable ER visits. How might that be addressed?

Roth: In an ideal world you want to treat patients in a manner that is close to their home, convenient to their needs and which embraces them in preventative health holistically. There are great examples of this happening throughout the healthcare delivery system, but it's not necessarily done at scale.

At Dignity Health we have been working with a connected inhaler that our teams have helped develop. That work resulted in 100% reduction in hospitalizations, and a 60% reduction in ER visits for children with challenging asthma conditions, with an average savings of $600 per patient per year.

We can scale that throughout Dignity. But if we are to truly address this problem as a nation, that means broader scale beyond what we can do. We are forward-leaning those types of methods and capabilities to scale to other areas of the country and other health systems.

We will also learn from other systems that address similar problems. It will be about understanding the challenges in the ER, and working together to cross the chasm with innovation that makes a difference, and to scale it nationally.

HLM: What metrics will you use to measure success?

Roth: We ultimately are going to measure success in the areas we focus on in their ability to reduce the cost of care, improve quality, and improve access for people who face barriers today.

For example, when you talk about ER overcrowding, interjecting more services that keep people out of the ER in a preventative way. That is a win for us, the systems, and individuals who get a more personalized experienced.

HLM: Where is CMS's role in this project?

Roth: While CMS is not an official member, per se, because that is not their role, we will absolutely work with their programs and advocate and support changes to policies and programs that allow for better support for these communities.

HLM: Andy Slavitt has been an outspoken critic of CMS and President Trump. Could his lead role in this project be seen as a shot across the bow?

Roth: Andy has sat in the CMS chair. He understands how to make change. He has created a strong bipartisan group out of the United States of Care, which includes people from both sides of the aisle. He's been a successful entrepreneur as well. He is going to be an important voice. But if you look at our assemblage of systems, they're from all over the country and they recognize this not as a political problem, but as a community health problem and a public health problem and that is the lens we all see this in.

We see this as an effort to serve patients in communities, regardless of what state you are in. The diversity of the systems in the project and where they're from speaks to that.

HLM: Your media release announcing the project struck a tone of urgency. Why?

Roth: The feeling is that healthcare is changing and we are seeing various issues that exist in our community. With the rise in certain conditions, such as opioids abuse and other public health and social issues, the only way to get in front of it is to take a leadership position and do so in partnership not only with peers but with the entrepreneurial community to create systems, models and processes that are sustainable and can impact change for populations.

Now is the time for forward leaning systems, entrepreneurs and others to partner together to create change. There is a tremendous platform out there. New technologies have been developed. We need to get them in practice, and we need to make sure they are addressing real problems in real communities in ways that helps the healthcare system become more sustainable.