Let's Help Medicaid Nurture Innovation

  | by Alice Dembner   |  SHARE f t

Spring is a great time to think about transformation, and everywhere you look these days, more initiatives are sprouting to improve the health system. Medicaid is no exception, showing again that it is a program willing and able to help states lead the way toward more effective and efficient care.

Recently, Medicaid officially launched a program of web-based support to speed states' efforts to improve health and health care for Medicaid beneficiaries. The initial focus is on new ways to pay for and deliver services for people with drug and alcohol problems, also called substance use disorders. It's a welcome spotlight on an area of care that has long been in the shadows.

Later this spring, Medicaid plans to roll out a second part of its Medicaid Innovation Accelerator Program (IAP) that will focus on super-utilizers of health care services, followed by other segments on community integration to support long-term services and supports, and on integration of care for physical health and mental health. These areas – all critical for better care for consumers -- were chosen with help from stakeholders using criteria that included need, opportunity and synergy with other federally supported innovations, including the State Innovation Models Initiative and the demonstrations for Medicaid-Medicare beneficiaries (dual eligibles). The IAP is being run jointly by the Center for Medicaid and CHIP Services and the Center for Medicare and Medicaid Innovation. Advocates and other stakeholders can respond to federal officials' request for comments on the three new issue areas at MedicaidIAP@cms.hhs.gov.

For each of these issue areas, Medicaid is providing a year of intensive, tailored technical assistance to a small group of states that is already moving forward, and a series of webinars and resources to any state Medicaid program just getting started on innovations to improve care and outcomes. Both the tailored coaching and the webinars focus on expanding new models, improving quality measures, payment and contract strategies that yield better value, and ways to share lessons quickly across states and the nation. The shape of those innovations will vary greatly state to state.

The states getting high-intensity coaching for substance use disorders work were selected in February: Kentucky, Louisiana, Michigan, Minnesota, Pennsylvania, Texas and Washington. It's great to see that states of all political persuasions signed up. Details of their planned innovations have not yet been released.

Medicaid has also started the web-based support for 19 other states who applied for the IAP. These SUD learning sessions will be grouped by topic areas, such as benefit design, managed care contracting, and integration of primary care and substance use services. The first session dealt with increasing provider capacity, a critical issue for substance use disorders, since only about 10 percent of those with problems get treatment. There's no limit on state participation in the web support, so Medicaid officials say more are welcome. A map of the learning community states and an outline of the topics will be posted on the IAP website in the next few weeks.

If your state is one of those in the intensive group, now's the time to reach out to the state official who is the lead on this. A good place to start is whoever directs substance use disorders services in your state's Medicaid administration. If your state hasn’t already jumped in, you can encourage Medicaid or Health Department officials to check out the opportunities. While advocates aren’t part of the project’s learning community, federal officials are expecting states to engage stakeholders, including consumer advocates. It's critical that consumers be at the discussion tables to make sure the new care models work for everyone.

Why are they starting with substance use? No surprise that it's partly about the money. The top diagnoses among Medicaid beneficiaries that lead to frequent, costly and potentially avoidable re-hospitalizations include substance use and mental illness. Studies increasingly show that screening for substance use and providing effective treatments –such as combining medications and counseling -- saves money and lives. But too few people are screened, many don't get the care they need, and others get fragmented care where treatment for substance use is segregated from care for other illnesses.  

The Medicaid IAP seeks to help states learn from each other, eliminate federal and state barriers to better, less costly care, and improve outcomes for consumers. Sounds like a model we know works. The issues are critical: substance use disorders, super-utilizers of health care services, community integration to support long-term services and supports, and integration of care for physical health and mental health. Let's get involved.