Modernizing Medicare and Medicaid means addressing the affordability crisis

Panelists for HLTH’s Medicare & Medicaid session were, from left: Dr. Marissa Rogers, executive medical director, Oak Street Health; Jay Bhatt, chief clinical product officer and medical director, Medical Home Network; Misu Tasnim, director of Digital Services, CMS; Alicia Stokes, VP of strategy planning and performance for government markets, BCBS North Carolina; and Natalie Davis, CEO, United States of Care. 

Photo: Jonah Comstock/HIMSS

Medicare and Medicaid populations must not be ignored in health modernization efforts, said panelists during the HLTH conference in Boston. On October 19, the panel took up the challenge of finding new ways to lower costs and improve outcomes for patients enrolled in Medicare, Medicaid, Medicare Advantage and dual eligible populations.

All stressed the importance of putting the patient at the center of care, as well as not defining patients by the groups they're in.

The panel, moderated by Natalie Davis, CEO of the United States of Care, included Alicia Stokes, vice president of strategy planning and performance for government markets at Blue Cross and Blue Shield of North Carolina; Dr. Marisa Rogers, executive medical director of Oak Street Health; Jay Bhatt, chief clinical product officer and medical director at Medical Home Network; and Misu Tasnim, director of digital services at the Centers for Medicare and Medicaid Services.

"Healthcare is a $3.8 trillion industry that's roughly 17% of our GDP. That number is expected to almost double by the end of the next decade, which clearly states the point that healthcare is unaffordable," Stokes said. "So, when we talk about modernizing Medicare and Medicaid, it's about the affordability crisis that we have to change, and we have to be able to turn the ship around."

Bhatt said it was important to look at modernization efforts from the perspective of reducing the patient's total out-of-pocket spending.

"We've looked at creating a kind of data liquidity and real-time data, along with a workforce that's able to access it and put it to work, built on health-risk assessments," he said. "That means structured workflows, addressing reliability and doing it consistently every time in a way that can deliver outcomes of reducing total cost of care."

By investing in those tools, resources, structures and partners to support those data-driven outcomes, Medical Home Network has been able to realize $100 million in shared savings over the last five years, Bhatt said.

Tasnim noted that while the conversation always turns towards moving towards value-based care, when it comes to making these decisions, "we're still running a policy that has that fee-for-service lean."

Rogers pointed out that from her experience they have learned putting a lot of resources upfront into primary care decreases long-term costs, including reductions in admissions, ER visits or readmissions.

"We've got to look at what is working well to decrease costs and replicating that on a more broad strategy level," she said. "We also recognize that for many of our patients, it's not just about the medical care, it's about the social and the legal factors that also impact care."

That means investing in teams of behavioral health specialists and social workers who can dedicate time for complex care management.

"They're really active with partnering together to make a personal healthcare plan for individual patients navigating barriers such as transportation, housing, food insecurity," she said. "All of these are really critical factors that impact the outcomes. And you can't do it by just addressing diabetes and hypertension." 

Rogers said the much broader impact can be made by addressing the larger social determinants of health. "When we talk about modernizing, we really need to think about, how do we incentivize providers to have a broader lens to care for patients to get optimal outcomes?" 

That point of view was shared by Tasnim, who said her teams are focusing on modernizing access, data streaming and quality of care for the patient, regardless of which program they happen to be in at that moment in time.

"It's about creating an affordable, high quality, equitable system of care that is sustainable and accessible to everyone that can access it," Bhatt said. "And that's the point. We've got to make it accessible to everyone."  

Twitter: @dropdeaded209
Email the writer: nathaneddy@gmail.com