Background and Need

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Medicaid beneficiaries have faced persistent challenges in accessing care, and these challenges have been further exacerbated by the COVID-19 pandemic. Research has shown that Medicaid beneficiaries experience disproportionate challenges in accessing both primary care and specialty services, and once Medicaid beneficiaries secure appointments, they face additional challenges finding affordable and convenient transportation. In addition, Medicaid beneficiaries have longer wait times for their appointments, yet spend less time with their providers. With non-essential services closing across the US and health systems rerouting their resources to manage COVID-19, Medicaid beneficiaries experience even more difficulty in accessing care. Low-income patients also disproportionately lack access to broadband internet at home and smartphones, which has excluded them from transitioning to telehealth compared to their counterparts during the crisis. 

Access to care and poor outcomes are of particular importance across two specific areas in Medicaid: maternal health (covering 43% of all births in the US) and behavioral health (nearly 1 in 5 Medicaid beneficiaries have a behavioral health diagnosis including a mental health condition). 

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For maternal care, improving maternal care extends beyond prenatal care and delivery, and includes woman's health, wellbeing, and conception to postpartum support. Access to care across the spectrum of maternal health can be limited or wholly unavailable. MACPAC reports that women with Medicaid are more likely to have had a prior preterm birth, a low-birthweight baby, or both, which increases the odds of a similar subsequent birth. 

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For behavioral health, Medicaid beneficiaries have higher rates of comorbidities, while there are lower reported rates of medication use, lower access to behavioral health providers (both outpatient and inpatient), and lower consistent use of behavioral health services once accessed. As a result, Medicaid beneficiaries have higher inpatient and ED visits related to behavioral health.
 

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Solutions

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Behavioral health and maternal health are complex care delivery mechanisms in Medicaid and consume significant focus and attention among State Medicaid Directors, plan leaders, and provider systems. Solutions should look to holistically address the Medicaid buyers in solving delivery needs, while considering policy and payment.

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We are interested in either behavioral health and/or maternal health solutions that positively impact Medicaid populations in accessing care, specifically such solutions that address high need individuals (considering economic vulnerability, transportation, digital access, and literacy). Solutions should be cognizant of an individual’s existing primary care networks and incorporate where and how people live to ensure cultural competency. COVID-19 is disrupting traditional access and this Focus Area seeks to find companies that enable patients and healthcare providers to overcome in-person barriers, while considering access and technology challenges. We value companies that can balance equity in delivery, quality outcomes, and value creation while eying growth across the millions of Medicaid beneficiaries that need services.