Baylor Scott & White Health, one of the largest nonprofit health systems in Texas, is joining more than a dozen health care providers across the nation to try to reduce the cost and improve the efficiency of caring for Medicaid patients.
Called the “Medicaid Transformation Project,” the national effort is designed to “transform health care and related social needs” for the more than 67 million Americans who rely on Medicaid for care, according to Avia, a network used by hospitals and health systems that focuses on innovation. The official announcement of the project was expected Wednesday.
Medicaid, used largely by low-income patients, pregnant women and children, and the related Children’s Health Insurance Program or CHIP, provided health care coverage for more than 4 million Texans, as of May.
While Medicaid represents a small portion of Baylor’s patient population — about 8 percent — rising costs and inefficiencies impact all health care consumers, said Jim Hinton, Baylor’s chief executive.
“When people use health care inefficiently, it costs everybody more money,” said Hinton in an interview with The Dallas Morning News. “That’s the No. 1 issue in health care today, far and away.”
Under the program, which will involve sharing best practices, the health systems first will focus on four key areas:
Mental health, which Hinton said is “an area in need of more systematic solutions in this country and state.”
Care for women and infants, which could include prenatal care and improved care for fragile infants. The Centers for Disease Control and Prevention counted 18 pregnancy-related maternal deaths per 100,000 live births in the U.S. in 2014, more than twice the rate in 1987. And 50 percent of U.S. births are financed by Medicaid, according to Avia.
Substance abuse, a growing concern in light of the opioid epidemic.
Reducing the number of avoidable emergency department visits. Medicaid patients “tend to use the ER room as their primary care center,” Hinton said. “It drives up the costs for Medicaid.” It also creates a backlog of patients in the emergency room, delaying care for those needing immediate attention.
Hinton said the Baylor system has been touched by each of those concerns. Specifically, it could share procedures it developed to help work with patients “who are at risk for repeated emergency department visits.”
Eligibility requirements to receive benefits under Medicaid vary by state. And Texas is seen as having more restrictive requirements than other states.
“As a percent of Texans, our Medicaid program covers fewer [patients] than in other states because it’s a fairly slim program,” Hinton said. “If 23 percent of Americans are covered, you would not necessarily expect to see 23 percent of Texans to be on Medicaid because of the way the [state] program is structured. There aren’t as many Texans eligible for these benefits.”
The new program is not designed to increase the number of eligible patients — a tally that is governed by the state. Its aim is to improve care and reduce costs within the existing system.
Baylor will serve as one of five “anchors” for the effort. The CEOs of the anchoring health systems will sit on a leadership council led by Andy Slavitt, former acting administrator of the Centers for Medicare & Medicaid Services.
“The leadership council will maintain the project’s course by taking ownership for action, prioritizing challenge areas, and supporting key elements of the work,” a Baylor spokeswoman said.
The other anchors are Advocate Aurora Health in Chicago and Wisconsin; Dignity Health in San Francisco; Geisinger in Danville, Pa.; and Providence St. Joseph Health in Renton, Wash.
Twelve additional health systems, including Memorial Hermann Health System in Houston, also will participate.
Collectively, the 17 health systems span 21 states, 280 hospitals with more than 53,000 hospitals beds, and bring in $100 billion in combined annual revenue.