Medicaid Transformation: Past, Present, and Future with Alan Weil of Health Affairs

Medicaid Transformation. 1115 waivers. Delivery System Reform Incentive Payment (DSRIP) programs. Expansion. Contraction. We’ve been at this for a long time. Why isn’t Medicaid transformed already? Well… it turns out that this is really difficult work. First off, there are complex political and ideological issues. Even if we all agree that we want the best healthcare for every American – a conceptually easy outcome to rally behind – we don’t all agree on what that looks like, how to get there, or how to pay for it. Second, it takes a long time for policy levers to play out in the real world. That makes it exceedingly difficult to measure the success of our programs, which further exacerbates the first issue. Add in a bunch of multi-billion-dollar entrenched institutions, technology hurdles, and social determinants of health, and you are still just scratching the surface of the many issues that need to be addressed and aligned to “succeed”. But all is not lost. We’ve learned a lot over the past 30-40 years, and we’ve made progress in many areas. There are approaches and mental models that have led to certain levels of success. And today’s guest has been participating in and observing many of them over the past few decades. Today we talk with Alan Weil, Editor-in-Chief of Health Affairs, the nation’s leading health policy journal.  Alan takes us through the history of Medicaid Transformation from the early 1980s on. We discuss the approaches taken, the thinking behind them, and the many factors that influenced their success. We explore the conflicts and hurdles, the friction and confounders, not to define a path forward, but to give the listener a more productive framing from which to build. This is admittedly a bit more of a philosophical discussion than what we usually have on this show. However, I feel we’ve taken a practical approach to the philosophical exploration and yielded actionable advice on how to adjust your frame. Please do let us know what you think!   For full show notes and links, visit: https://thehcbiz.com And of course, find everything from Health Affairs at: https://www.healthaffairs.org/