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What One Medicaid Insurer Appears for From Potential Well being Tech Distributors

What One Medicaid Insurer Appears for From Potential Well being Tech Distributors


Digital well being firms usually begin within the industrial market and thereafter goal Medicaid plans. However not all startups are suited to serve the Medicaid inhabitants, in keeping with Dr. Pooja Mittal, vp and chief well being fairness officer at Well being Web. That’s why Well being Web created a vetting course of to grasp which firms have the potential to be the best with Medicaid members.

The California-based insurer affords well being plans for people, households and companies and has three million members, together with those that qualify for Medi-Cal or Medicare. Mittal famous that when the corporate began bringing in new distributors about 4 or 5 years in the past, some have been very profitable working with its Medicaid inhabitants, whereas others struggled with engagement.

“What we realized was that there have been plenty of firms that didn’t have expertise within the Medicaid area that have been making an attempt to enter into that area with out a good understanding of what’s required,” Mittal mentioned throughout an interview final week on the Behavioral Well being Tech 2023 convention held in Phoenix.

To fight this problem, the insurer began a request for info course of from potential well being tech distributors, Mittal mentioned. This course of requested distributors particular questions on well being fairness, together with if the corporate has ever served the Medicaid inhabitants earlier than, the way it drives engagement and what the corporate’s engagement charges have been with Medicaid members.

“Utilizing that, we’ve been far more conscious about how we usher in digital expertise and the way we take into consideration these issues. … Whether or not you may entry schooling that’s in an app offline or whether or not you want a considerable amount of knowledge to have the ability to entry that info will differentiate whether or not you’re going to achieve success with the Medicaid inhabitants,” Mittal mentioned.

One instance of an organization that Well being Web works with is Pair Crew, which simply secured $9 million in Sequence A funding. The corporate particularly works with Medicaid plans and companions with native community-based organizations, similar to meals pantries and shelters. Pair Crew trains the workers of those organizations to grow to be group well being employees to allow them to present care navigation providers, well being advocacy assist and different providers. Sufferers are then additionally linked with Pair Crew’s digital telemedicine group, which features a registered nurse, nurse practitioner and behavioral well being specialist. One other vendor that Well being Web works with is Pyx Well being, which affords an app that combats loneliness via chatbot and human assist. If members don’t have a smartphone, they will work with the corporate’s workers over the cellphone.

Mittal’s feedback about vetting digital well being distributors come at a time when payers and employers are battling vendor fatigue. Nevertheless, startups are sometimes hesitant to work within the Medicaid area, and digital well being firms that concentrate on Medicaid usually battle to get funding. Nonetheless, whereas many startups aren’t serious about pitching to Medicaid insurers (possible partially attributable to regulatory challenges), there are nonetheless fairly a number of that can, in keeping with Mittal.

“I feel we’ve simply gotten extra subtle at asking the correct questions to essentially assess whether or not we’re going to achieve success with a vendor. … Even in a sea of 4 or 5 distributors doing the identical factor, as soon as you actually drill down, you’ll usually discover that there are one or two which might be actually going to fulfill the wants of a Medicaid inhabitants in an equitable means, which have been designed with fairness in thoughts from the beginning,” she mentioned.

Picture: designer491, Getty Pictures



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