Medicaid Transformation Project
The Medicaid Transformation Project is a national effort to transform healthcare and related social needs for the most vulnerable. Throughout this initiative, health systems will implement innovative solutions that address challenges like behavioral health and substance use disorder to improve health for underserved individuals and families across the country.
In partnership with healthcare leaders and Andy Slavitt, our mission is to change the health and care of the Medicaid population by leveraging digital solutions and innovative care models to more effectively and efficiently meet the needs of ~75 million Americans and other vulnerable populations.
The impact and opportunity:
- One in five Americans are covered by Medicaid
- 50 percent of U.S. births are financed
- Medicaid is the country’s number one payer for behavioral health services
- 33 cents of every dollar for a physician's services are paid by Medicare or Medicaid
- $15B in incentives available for innovative care models
- $650B estimated Medicaid & Duals market size
A shared vision
- Behavioral health
Approximately 9M adults on Medicaid are diagnosed with mental illness and Medicaid spending for these patients is 4x higher than normal.
How can digital solutions integrate behavioral health screenings into low acuity sites of care and improve appropriate access to mental health care?
- Substance use disorder
Over 30,000 people die every year from heroin and painkiller overdoses and in 2009, the US spent $24B on substance use disorder treatment; 69% came from public sources.
How can innovations improve the infrastructure and organization of substance use treatment and recovery?
- Women and infant care
Medicaid pays for over half of all US births and covers ~25M adult women; this population struggles with appropriate access to prenatal care, which is a top factor in reducing low birthweight infants.
How can digital solutions improve maternal visit attendance and coordination between visits to improve infant outcomes?
- Avoidable emergency
On average, health systems are paid 36 cents on every dollar spent for ED visits by Medicaid patients and ~ 1/3 of Medicaid patients visiting the ED show up at least four times in a calendar year.
How can innovations improve access to appropriate and timely lower cost and acuity care settings?
Partners in action
The Medicaid Transformation Project is led by AVIA and former CMS Acting Administrator Andy Slavitt. Since leaving government, Andy has founded Town Hall Ventures, a venture capital firm devoted to investing in and supporting entrepreneurs who are improving the health of underserved populations.