Mark Larson and Stephen A. Somers, PhD

November 17, 2016

The Medicaid program remains the largest health insurer in most states and the one most responsible for our citizens with complex clinical and social needs. Unlike the leadership of most large companies, state Medicaid directors and their top staff get very little support for leadership training and organizational capacity building. As a partial response, the Center for Health Care Strategies (CHCS) has over the years initiated a Medicaid Leadership Institute for Medicaid directors — the lead author of this blog being one of its competitively selected Fellows — as well as a series of state-level Medicaid Academies in California and New Jersey, more recently in New Hampshire, and soon in Vermont.

vermont-academy-blog-postWith the elections of 2016, the need for these kinds of support could not be greater. In an uncertain future for publicly financed care for low-income Americans, it is critical for state officials to: (a) track the strategies and policy responses being developed by other states across the country; and (b) strengthen their own leadership capacity to adapt to and manage change. These are the two main objectives of CHCS’ Medicaid Academies.

Vermont has over the past several years, been a leader in innovation in publicly financed care. To continue to improve outcomes for Vermonters, the state is now investing in its managers within the Vermont Agency of Human Services (AHS) through the Vermont Medicaid Academy (VMA). The VMA is a unique professional development and leadership training program for managers across AHS. It is generously supported by the New England States Consortium Systems Organization (NESCSO) as part of its State Health and Human Services Training and Leadership Development Initiative. The VMA will give participants a comprehensive overview of the Medicaid program nationally and provide a context for fully understanding its critical role in the Vermont health care system now and into the future. NESCSO is also supporting the New Hampshire Medicaid Academy, which launched in early November with curriculum directly tied to the state’s 1115 waiver efforts to transform care. Look for more in a future blog post.

What is truly groundbreaking about the Vermont Medicaid Academy is the length to which the state is going to build cross-agency understanding and collaboration that fully reflects the complexity of creating a “culture of health” for its beneficiaries. This demonstrates the commitment of AHS leadership to break down siloes and achieve its Agency of One vision. By setting aside “seats at the table” for each of the following agencies — Medicaid, public health, mental health, substance use disorder, criminal justice, child welfare, and aging/independent living staff — Vermont is acting upon its conviction that it takes a lot more than health care to make communities and their residents healthy.

The other states for which CHCS is conducting Medicaid Academies are taking similar steps to incorporate more county and/or cross-agency partners into their respective training programs for very similar reasons. It is gratifying to be part of these transformations of pure health care purchasing agencies into purveyors of a broader vision of population health. No matter what changes occur at the federal level, some form of public financing of health care for 70 million low-income Americans will continue. The capacity of state leaders to be strategic, adaptive and collaborative will go a long way to improving the health care and the life chances of their citizens.

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