In this inaugural edition of Transforming Medicaid: Expert Perspectives, Waymark’s expert perspective series on Medicaid transformation, Afia Asamoah, Waymark co-founder and General Counsel, Head of People, speaks with Adimika Meadows Arthur, Executive Director and CEO at HealthTech 4 Medicaid, an organization dedicated to advancing technology solutions that improve care for people enrolled in Medicaid.
With recent policy changes creating both challenges and opportunities in the Medicaid landscape, there's never been a more important time for thought leaders to gather together and bring their best thinking to bear to find ways in which we can transform Medicaid for the patients it's designed to serve. Adimika, thank you so much for joining me today.
In your opinion, how is the current policy environment affecting technology investment and innovation efforts in Medicaid? Do you see opportunities, challenges, or both?
We saw a bit of a seismic shift happen on July 3rd. Whether we want to acknowledge it that way or not, it’s the first time we've seen federal work requirements codified into law, and that opens the door for a lot of things, good, bad, and indifferent. Right now, a few weeks in, no one knows the exact playbook of what to do. We've got a federal floor and state ceilings, and in those state ceilings we've got 50-plus different ways that we can build structures and solutions.
I think the biggest thing that it opens up from a policy environment is the hottest topic that we've been circling around: AI-driven enforcement and investment. I think it's important to acknowledge that right out the gate. The biggest fears I've heard on the ground from community members, and the most questions I've heard from state lawmakers, have been around AI-driven work. So that means states are going to increasingly use technology not just to serve, but also to survey and to disqualify, and also to enhance and promote patient care.
I tend to be a glass half full kind of person, and HealthTech 4 Medicaid and many others are trying to meet the moment. We recognize that we can and should use this moment to create guardrails for ethical AI usage in healthcare, we can create conversations around AI that we’ve never really had before, and we can talk to our communities about AI in proactive ways. Right now, we’re calling on thought partners to help co-create some of these frameworks that protect people – not just patients, because you don't need to be a patient inside the four walls of a clinic or a hospital in order for us to create those protections. We can center trust in what we build right now, and can ask ourselves who our trusted partners are, and who should be building these systems for us. I think we have the biggest opportunity right now, with the biggest piece of Medicaid policy, and bringing the two of them together is the best way we can advance care delivery right now.
From your perspective, what are the most significant challenges facing people enrolled in Medicaid today? How can technology be part of that solution?
At HealthTech 4 Medicaid, we always say that Medicaid is the closest thing we have to a national health plan. That said, it's also one of the most structurally uninvested and politically vulnerable parts of our healthcare system. Today, almost all Medicaid enrollees face enormous barriers: long wait times, fragmented systems, confusing eligibility processes, limited access to culturally-competent care, and administrative burdens.
So I do believe technology will be able to help us address this – it already has – but that technology needs to be deployed equitably and created with the intention of ensuring enrollment [in Medicaid] is made easier, not harder. We need digital solutions that are human centered, inclusive, and equitably designed to meet people where they are, whether that's a caregiver at home who may have limited English proficiency, or a community health worker who's on a tablet that doesn't have access to a broadband system. These solutions need to be co-designed with our communities and not just built for them. That’s how we’re going to turn our innovation into impact.
I so appreciate the framing and very concrete examples of places where technology can scale, and be used to improve care delivery outcomes and, frankly, save costs. Can you share some concrete examples of technology that has been working to improve care delivery for Medicaid populations? What about those approaches actually makes them work?
I could give millions of examples; Medicaid's been a part of my career for a very, very long time, and patients receiving Medicaid have been part of my personal life too. When I was a hospital leader, I kept seeing all of these incredible innovations happening around me, but folks not really concentrating on the population that really undergirds most of our society: the one in almost-five patients receiving Medicaid benefits.
We can't build technology for just one subset of our society and think that the rest of us can actually function well; I think we've learned that through many iterations, the COVID-19 pandemic being one of them. I think we've made incredible advancements in certain disease states because of technology and technology enablement, and Waymark has done an incredible job at helping enable community-based care teams outside of clinics to connect patients to care
We’re also seeing a lot of pushing from the public health side on video coaching and video work: directly observed therapy, virtual and telehealth options, and so on. We've seen how this supports medication adherence, particularly in chronic disease care, maternal health and behavioral health. The integration of video care options are huge advances that have really helped care delivery teams directly work, using Zoom or their phone, to actually help patients advance their care and their lives – Waymark also does a great job of that as well.
On top of what you've said, Waymark has also been collecting data to show what innovations are working for what types of people. We're getting smarter in terms of how we can deploy technology to truly be impactful for different kinds of folks. As you said, we're not working within a monolith and we should be really intentional in terms of co-designing and making sure we're developing things that are actually going to work.
What's your key message for stakeholders that are investing in these tech solutions, or even building these tech solutions?
I think people have gotten really confused about what Medicaid is. It’s just an insurance program. There is a large number of people – one in four, almost one in five people living in America – who utilize Medicaid as their means of getting healthcare, and so therefore, it’s as close as we're going to get to a national healthcare system.
The purpose of Medicaid should be to make sure as many people as possible can access quality and equitable care. The future of health justice is Medicaid.
