Opinion

Health Care Progress and Innovation Gain Momentum with Virginia Medicaid Decision

Access is the first step to good health care. Undoubtedly, greater access to health care for more families is a public good, but we must go one step further to ensure the care we provide is of high value and quality.

Gov. Ralph Northam (D) recently expanded Medicaid and signed a law giving 400,000 more Virginians access to health care. This made Old Dominion the 33rd state to use the options available under the Affordable Care Act that aim to eliminate coverage gaps that leave many hard-working families without insurance.

All told, about 20 million more people have health coverage today as a result of the ACA and Medicaid expansion, and millions of families can obtain the medical care they need. And this is good news. Studies show us that adults and children with a Medicaid health plan have significantly better access to care and preventive services than people with no coverage.

America has long led the world in medical science. We develop pharmaceutical treatments, surgical procedures, gene therapies and medical devices that are nothing short of amazing. This leadership in development helps us provide high-tech care for patients of all ages. But, we’ve been challenged to treat people in one important area — chronic disease.

Nearly half of all adults in the United States have at least one chronic condition, and about $4 of every $5 we spend on health care goes toward their treatment. In Virginia alone, the total cost of treatment for chronic conditions from 2016 through 2030 is likely to exceed $1 trillion. Fortunately, though, these conditions can often be managed or even prevented through behavior modification rather than high-tech care. Better yet, the resources to prevent and manage chronic conditions are available through managed care options covered by Medicaid.

This is why Virginia was smart to leverage Medicaid as a way to achieve efficient care. The vast majority of the state’s beneficiaries — and 55 million of the 67 million total Medicaid enrollees nationwide — use a managed care plan. These programs allow states to partner with private insurance companies to ensure people have access to the innovations coming out of the private sector.

A central feature of this model is care coordination, which guides patients to use services appropriately and to manage multiple conditions. Coordination allows insurers to identify high-risk members, such as people with chronic disease, and nudge them toward a healthier lifestyle. This means orienting people to primary care, alerting them to free preventive services and addressing social determinants of health to reduce the likelihood of obtaining care in expensive care settings like hospitals.

Many health plans are also bringing technology to bear. Pack Health, for example, is working with various payers to implement digital coaching and tools to help people better navigate the complex health care system. These high-touch, tech-enabled programs empower members to visit their doctors, make healthier choices and save money.

Bottom line, health insurers are increasingly incentivized to take advantage of managed care options. As it becomes easier to schedule a health screening, get answers about nutrition or overcome transportation barriers, members are more inclined to take positive and preventive actions. Additional education and support provided through digital health coaching can take this to the next level by supplying the information, encouragement and real-time feedback patients need to access the right resources at the right time and be held accountable to health goals.

Health insurance has always been an asset, but recent changes have made it more valuable than ever in helping Americans stay healthy, productive and engaged at work, with family and in their communities. The United States has taken major strides toward bettering our health care system, and Virginia is embracing the reforms it believes will have a significant impact on the Medicaid population.

Now, it’s up to all of us to preserve and build on this momentum to further increase access and improve quality of care.

 

Mazi Rasulnia is the founder and president/CEO of Pack Health, a digital health coaching company based in Birmingham, Ala.

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