United Hospital Fund’s annual Medicaid conference went ahead as planned on July 15, but in a new format suited for these pandemic times—some 250 people watched the presentations in a live webcast rather than in an auditorium, and submitted questions virtually to the presenters. The switch to a new delivery format was appropriate given that much of the day’s presenters discussed the many ways that the coronavirus crisis will change how health care is delivered and paid for in New York State.
The 2020 conference focused on Medicaid as a vital program for improving health equity, specifically considering how the COVID-19 pandemic has brought new awareness to historic health disparities. UHF President Dr. Anthony Shih said in his remarks that “we are in a unique historical moment, here at the confluence of COVID-19 and a reawakened social justice movement, with an opportunity to improve our health care system so that we achieve longer-term progress toward health equity.”
The conference’s title, Fostering Equity During a Time of Crisis, was echoed by New York State Medicaid Director Donna Frescatore in her opening keynote. “Medicaid must play a role in addressing disparities and fostering equity,” she said. Ms. Frescatore pointed out that Medicaid and other public insurance programs are proving more important than ever during the crisis, underscored by the fact that more than 300,000 New Yorkers enrolled in Medicaid since March, when the pandemic escalated. The program now covers more than 6.3 million people in the state.
New York State Medicaid Director Donna Frescatore speaks to Medicaid Conference virtually
New York made a number of decisions that helped expand the safety net during this crisis, Ms. Frescatore said, including extending the sign-up period for Medicaid and other coverage under the Affordable Care Act for people who may have lost their jobs and their existing health coverage. She outlined many of the changes that the state’s Medicaid program has made during the pandemic, such as new flexibility in authorizing home- and community-based services and reimbursing telehealth services. Ms. Frescatore also provided an update on New York’s Medicaid Redesign Team II recommendations and summarized the state’s efforts to foster equity in areas such as maternal and child health, chronic disease management, and addressing social determinants of health.
The morning panel, Advancing Equity in Maternal Health, examined opportunities for Medicaid to promote health equity by improving maternal care and reducing maternal mortality. The panel, moderated by Suzanne Brundage, director of UHF’s Children’s Health Initiative, included Elizabeth A. Howell, MD, professor and director of the Blavatnik Family Women's Health Research Institute at the Icahn School of Medicine, Mount Sinai; Ngozi Moses, executive director of Brooklyn Perinatal Network; Aimee Smith, DO, clinical director of maternal medicine at the Institute for Family Health; and Wendy C. Wilcox, MD, chairperson of the Department of Obstetrics, Gynecology and Women's Health, at NYC Health + Hospitals/ Kings County.
Ms. Brundage noted that over 40 percent of births in New York State are covered by Medicaid, making it an important vehicle for addressing maternal health disparities. Those disparities are extreme in New York: while Black women are at least three times as likely to die from a pregnancy-related cause as white women nationwide, in New York City they are eight times more likely to die than their white counterparts, according to Dr. Howell. Even Black women with a college education are five times more likely to die in the city from pregnancy-related causes than white women with a college education.
The panelists discussed the value of innovative preconception, prenatal, and postpartum practices that address disparities by integrating medical care with social services and supports. Ms. Moses described one such example: the Brooklyn Perinatal Network’s Pathways Community Hub, a model that convenes community-based organizations into a network to standardize and coordinate delivery of social services and to collect data that informs population health planning. “Trust, collaboration, and financial resources can lead to tremendous return on investment from medical-CBO collaborations,” Ms. Moses said.
Tekisha Dwan Everette, PhD, delivering midday keynote, “Medicaid’s Role in Advancing Health Equity”
The midday keynote, titled Medicaid’s Role in Advancing Health Equity, was given by Tekisha Dwan Everette, PhD, executive director of Health Equity Solutions. Dr. Everette started by saying that we must acknowledge and understand the impact of racism in the delivery and execution of health care, and she urged the audience to examine and address the institutional and structural racism at the roots of social determinants of health. Her keynote identified three broad opportunities for Medicaid to advance health equity: promoting inclusion and equity by engaging Medicaid members in reforms; improving access to care by addressing barriers to telehealth and provider availability; and using new data and measures to drive progress toward equity in outcomes.
The afternoon panel, Primary Care as a Catalyst for Equity, was helmed by Laurie Zephyrin, MD, vice president, Health Care Delivery System Reform, at The Commonwealth Fund. The panel members were Sachin Jain, MD, chief clinical transformation officer for Community Healthcare Network; Kimberly Kilby, MD, senior leader of Regional Medical Directors at MVP Health Care; Tricia McGinnis, executive vice president and chief program officer for the Center for Health Care Strategies; and Navarra Rodriguez, MD, president and chief medical officer of AdvantageCare Physicians.
Dr. Zephyrin’s opening remarks highlighted how primary care can promote health equity by integrating care and tailoring delivery to populations’ and patients’ unique needs, contexts, and experiences. The panel members explored how Medicaid might achieve greater health equity through innovations in primary care payment and delivery that improve patient outcomes and promote better population health, including efforts to engage patient communities, partnerships with community-based organizations, new data strategies, and managed care reforms addressing disparities. They focused on how best to address social determinants of health and the usefulness of telehealth, especially during the pandemic, in reaching patients who may find it difficult to come into a clinic. However, reimbursement issues for telehealth must be addressed for it to reach its full potential, Dr. Rodriguez said.
Slide presentations for the meeting can be found here.
The conference was presented with support from The Commonwealth Fund.