Sep 24 2013

Public Health and Medicaid Partner in States to Improve Health Outcomes

ASTHO 2013's "Medicaid and Public Health: Improving Partnerships" Panel

GUEST POST by Virgie Townsend, JD, associate editor at the Association of State and Territorial Health Officials (ASTHO)

About 40 percent of the health care dollars spent in New York State come from Medicaid. Realizing that the rate was climbing far too fast, the state brought together health care advocates, physician representatives, elected officials, management and unions to solve the growing financial issue by addressing the social determinants.

And they were effective. Last year the state saved $4 billion while adding approximately 154,000 people to its Medicaid program.

One of the key figures behind the public health improvements was New York State Health Commissioner Nirav R. Shah, MD, MPH, who last week moderated the panel discussion “Medicaid and Public Health: Improving Partnerships” at the Association of State and Territorial Health Officials’ (ASTHO) 2013 Annual Meeting.

>>Read more in a NewPublicHealth Q&A with Shah.

>>Read more on New York State’s Health Improvement Plan.

>>Follow continued ASTHO Annual Meeting coverage on

In addition to Shah, the panel included Vermont Department of Health Commissioner Harry Chen, MD; Executive Director of the National Association of Medicaid Directors Matt Salo; and Chief Medical Officer for Center for Medicaid and CHIP Services Stephen Cha, MD, MHS. Shah and Chen discussed how their states are improving population health through greater integration with Medicaid, while Cha and Salo presented their views from the Medicaid perspective.

New York State Health Commissioner Nirav R. Shah, MD, MPH

Shah began the session by describing how the New York governor convened a group to address Medicaid health outcomes and preventable hospitalization challenges. The group examined how to bend the cost curve, improve outcomes and generally “fix” Medicaid.

“Time and time again, the answers came from public health,” Shah said.

The group ultimately adopted 78 measures, many of which were based in public health, including covering lactation counseling for pregnant women and podiatrists for diabetics. New York also eliminated coverage for ineffective items. The billions of dollars in savings from these combined efforts will be invested back into public health to further prevent illness and injury.

Chen said that the Vermont Department of Health has been successfully working with Medicaid since 2005 on issues such as lead abatement, substance abuse treatment and healthy housing.  In order to achieve effective partnerships with Medicaid, Chen advised his fellow state and territorial health officials to talk dollars and cents with Medicaid and to rally around aligned goals.

“You need a conceptualization from your health department on how you align with Medicaid. Does everyone know their Medicaid directors? Make sure you do. We work for the same boss, whether it’s the governor, secretary of the agency, or the legislature,” said Chen, adding that you also need to “Think about questions you can ask to put the focus on population health.”

Public health departments can be extremely beneficial to Medicaid because public health is a trusted convener that can bring together community partners and providers at the discussion table, according to Chen.

Chief Medical Officer for Center for Medicaid and CHIP Services Stephen Cha, MD, MHS

Cha urged health officials to think critically about how to work with Medicaid and make their goals fit together.

“We cannot move forward without pathways and connections,” said Cha. “Think about how your tools can interact with Medicaid and how you can develop them. This is your time to prep your case.”

He presented three pieces of advice to facilitate Medicaid connections: one, think about how public health and Medicaid tools work in the context of health delivery; two, make Medicaid’s and public health’s goals fit together; and three, understand the new health care, Medicaid and public health paradigm.

Cha also identified hospital users as an area in which there are great opportunities for public health and Medicaid to work together.

“I have a ton of calls from states on hospital super-users,” Cha said. “States are really interested in this because they see it as an opportunity to reduce costs. When you think about how to do that, it’s all the stuff you’ve already been doing, so it’s about opening up those channels and connecting what you’re doing with how it can benefit Medicaid.”

Salo agreed that Medicaid-public health partnerships are essential to changing the fee-for-service healthcare system, and that “we need to create the financial incentives for people to think differently [about public health in Medicaid].”

Additionally, he encouraged health officials to look to manage care as a way to address issues that Medicaid is unable to cover.

Tags: ASTHO, Medicaid, Partnerships, Social determinants of health