Improving Care for Older Adults Through Medicaid Innovation

Background

As the largest public health care program in the United States covering over 80 million individuals and the primary payer of long-term services and supports, Medicaid plays a critical role in providing health care coverage to millions of older adults. Yet many Medicaid beneficiaries have limited ability to receive longitudinal, comprehensive care. Further, there are challenges in ensuring Medicaid coverage results in access to care, promoting high-quality care for all Medicaid members, and reducing widespread and long-standing health inequities – particularly across racial and ethnic groups – in care quality and health outcomes. At the same time, older adults enrolled in both Medicare and Medicaid programs (dual-eligible beneficiaries) face additional challenges navigating the complexities of two systems, resulting in a poor beneficiary experience as well as system inefficiencies. 

Despite the need for more coordinated, comprehensive care for the higher-risk populations and communities served by Medicaid, there has been less entrepreneurial activity and innovation in care delivery for Medicaid beneficiaries, particularly older adults, and innovations that do exist have not scaled widely. There is also often distrust between stakeholders involved, a lack of understanding about each other, and limited collaboration to improve care for older adults in Medicaid.

Project Overview

This project focuses on uniting public and private leaders in an unconventional coalition in service of addressing the needs of older adults in Medicaid. For this work, Duke-Margolis is examining factors that impede collaboration across public and private stakeholders and exploring ways for entrepreneurs, investors, and policy makers to build trust and keep a collective focus on improving care for older adults in Medicaid. This work is done in collaboration with Health Tech for Medicaid (HT4M) and is designed to not only address the unique challenges faced by older adults in Medicaid but also to serve as a catalyst for inclusivity and high-impact health policy work.

This project is supported by a grant from The SCAN Foundation. This work also builds off a series of meetings supported by a gift from a16z bio+health and West Health as part of a collaborative initiative to advance and accelerate value-based payment.