Lorie Martin

July 30, 2019

Tricia McGinnis, executive vice president and chief program officer (left) and Allison Hamblin, president and CEO (right).


Earlier this month, the Center for Health Care Strategies welcomed a new generation of senior leaders: Allison Hamblin, MSPH, president and CEO, and Tricia McGinnis, MPP, MPH, executive vice president and chief program officer. We recently sat down with Allison and Tricia to get their first-hand take on the opportunities they see for promoting delivery system innovations in Medicaid, the burgeoning role of cross-sector collaboration, and CHCS’ ongoing focus in partnering with stakeholders across the nation to catalyze and implement better ways of caring for high-need populations.

Q: Since its founding in 1995, CHCS has worked with stakeholders across the Medicaid delivery system to foster innovations. Moving forward, what do you see as key focus areas of opportunity for the organization?

A: A. Hamblin: CHCS will continue to focus on the levers that we have developed and strengthened over many years. First and foremost, this means keeping our finger on the pulse of the most important and timely issues facing Medicaid stakeholders at multiple levels of the system — including federal and state policymakers, health plans, health systems, providers, and increasingly community members — so we can make sure we’re focusing on what consumers want and need.

Also key for CHCS is cultivating networks of leading practitioners whom we can call upon to work together and test new approaches, accelerating the pace of learning through peer-to-peer sharing. Another core part of our approach is translating what we are learning from our innovative partners into tangible lessons that we can disseminate broadly. Finally, we will continue to build upon our role in supporting leadership development and capacity building among state Medicaid agencies. These efforts are helping state leaders achieve their policy goals, and also help CHCS stay in touch with the most pressing state priorities in a way that informs our ongoing program development efforts.

Q: As health care stakeholders recognize the need to go beyond medical care and address social needs, how can Medicaid transition to focus on social determinants of health (SDOH)?

A: T. McGinnis: I think that there are four key areas where Medicaid agencies can best position themselves on addressing social determinants: First, look beyond their own walls to other state agencies. Although Medicaid holds the purse strings of health care spending, state agencies for education, housing, transportation, and public health are critical partners to addressing SDOH. Second, leverage the flexibility that states have within federal regulations to work with their managed care and health plan partners to invest in SDOH interventions in partnership with providers, community-based organizations (CBOs), and others who are knee-deep in this work. Third, consider ways to use existing investments in delivery system transformation and payment reform to create more explicit incentives for addressing SDOH. And finally, identify the gaps that Medicaid is uniquely positioned to fill and the best role for health plans, providers, and CBOs. North Carolina, for example, is identifying gaps in addressing social needs and then deciding what unique role Medicaid can play — either in financing that gap or in finding the capacity to fill it so that different parties can work together more effectively.

Q: Where do you see Medicaid priorities aligning with those of the broader health system?

Medicaid has an important role to play in helping to reallocate resources to higher value services, which is critical to attaining a health care system that is sustainable from a financing perspective and producing the type of health outcomes we want.

A: A. Hamblin: As Medicaid covers nearly a quarter of the U.S. population, its challenges generally align with the broader dynamics facing the health care system overall. That said, some of health care’s biggest challenges are most acutely faced in Medicaid given the demographics of the Medicaid population and the dynamics of Medicaid funding. Medicaid typically has tighter resource constraints compared to the private market, so if we can figure how to get it done in Medicaid with greater needs and fewer resources, we can point the way for other partners in the health care system. For example, Medicaid is leading the way on how to better resource the behavioral health system and the mainstream health care system to address unmet needs for mental health and substance use disorder (SUD) treatment. In addition, Medicaid is on the frontlines of the aging baby boom, given its central role in financing long-term services and supports. Both of these examples also touch on the general need for workforce development, which is a huge opportunity for increased alignment across all segments of the market.

T. McGinnis: Another key area of alignment is health care costs. Though in many ways Medicaid is different from other payers, one common dynamic is that we spend way too much on unnecessary hospital services and not enough on primary care and behavioral health, which are woefully underfunded, but high-value. By using its regulatory authority and payment reform, Medicaid has an important role to play in helping to reallocate resources to higher value services, which is critical to attaining a health care system that is sustainable from a financing perspective and producing the type of health outcomes we want.

Q: How is the focus on cross-sector collaboration changing the landscape for health care delivery? What still has to happen to ensure sustainable change?

These collaborations take time to build, given differences in terminology, funding streams, and accountability; however, there is often the potential for early wins that can help build trust and relationships.

A: A. Hamblin: In our own work, we’ve come to appreciate that across sectors, we’re often dealing with the same problems, just from different perspectives. Through cross-sector collaboration, there is an opportunity for greater collective impact when we bring our health care policy tools to the table alongside our partners who have their own tools, and together think more holistically about how to solve common problems. These collaborations take time to build, given differences in terminology, funding streams, and accountability; however, there is often the potential for early wins that can help build trust and relationships.

For example, we know of “quick wins” in California, where the state’s Health in All Policies task force sought to leverage state procurement efforts to advance shared goals. In one example that focused on increasing access to healthy food, the task force helped both the state’s schools and the state’s corrections system insert higher nutritional standards into its food services contracts – including by lowering the sodium content in food provided to inmates across the state. It’s not always that easy, but often there are low-hanging fruit that we can identify just by connecting the right people in different agencies, each with their own tools and expertise to share.

Q: Are there areas of emerging focus that you are particularly excited about?

Part of our responsibility at CHCS is to keep our feet firmly rooted on the ground solving today’s problems, but also keeping our eyes to the sky — looking to help bring in new ideas and find homes for them where they can have the greatest impact.

A: T. McGinnis: I’m excited to see that health equity is re-emerging as an area of focus, not as a separate priority, but intentionally integrated into interventions, programs, and policies that are designed to transform care delivery. For example, payment reform presents a significant untapped opportunity to reduce disparities. Through support from the Robert Wood Johnson Foundation, we are working with the University of Chicago and the Institute for Medicaid Innovation on a project that brings together states, health plans, and providers to test new approaches for using payment reform to reduce health disparities for populations such as pregnant women, young children, and persons with criminal justice involvement. I’m encouraged to see the Medicaid policy world taking a fresh look at how to meaningfully incorporate health equity into all the work that we do, so that it becomes a core facet of how care is financed and delivered.

A. Hamblin: I’m particularly excited about the increasing focus on a “life course” approach to health care delivery. In recent years, our work to improve outcomes for adults with complex health and social needs and our support for implementation of trauma-informed approaches to care have highlighted the “early roots” for so many downstream costs in the health care system. Thinking from a population health and prevention standpoint, when you reframe health care as the responsibility to care for an individual across his or her lifespan, all of the questions and challenges around return on investment look quite different.

I’m also excited about opportunities for disruptive innovation. Health care delivery might look fundamentally different in 10 years. There is so much innovation going on and also a growing awareness that Medicaid is a compelling business opportunity for entrepreneurs and the startup community. There are likely to be disruptive and low-cost technologies that can benefit Medicaid beneficiaries more so than any other segment of the marketplace. Part of our responsibility at CHCS is to keep our feet firmly rooted on the ground solving today’s problems, but also keeping our eyes to the sky — looking to help bring in those ideas and find homes for them where they can have the greatest impact.

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Talmage M. Holmes, PhD, MPH

Many of the concepts you talk about align with the framework presented in Public Health 3.0, especially cross-sector collaboration. I work for Tarrant County, Texas, a large county health department, which is interested in moving the needle related to disparities and health equity. Do you see value in trying to work with Medicaid to design ways to address the issues locally?

Tricia McGinnis, Center for Health Care Strategie

Yes, we think there is a huge opportunity for local public health departments to partner with Medicaid, especially the Medicaid managed care plans operating in their community. States like Texas are increasingly building in contractual requirements for their plans to address social determinants and other population health needs. Partnerships with local health departments are a great way for health plans to meet those requirements, and we see a lot of enthusiasm in both community-based and national plans to engage with local partners. You might also be interested in the new Cross-Sector Innovation Initiative from the Public Health National Center for… Read more »

Talmage M. Holmes, PhD, MPH

Thanks so much for your timely and relevant response.