Digital health companies often start in the commercial market and thereafter target Medicaid plans. But not all startups are suited to serve the Medicaid population, according to Dr. Pooja Mittal, vice president and chief health equity officer at Health Net. That’s why Health Net created a vetting process to understand which companies have the potential to be the most effective with Medicaid members.

The California-based insurer offers health plans for individuals, families and businesses and has three million members, including those who qualify for Medi-Cal or Medicare. Mittal noted that when the company started bringing in new vendors about four or five years ago, some were very successful working with its Medicaid population, while others struggled with engagement.

“What we realized was that there were a lot of companies that didn’t have experience in the Medicaid space that were trying to enter into that space without a good understanding of what’s required,” Mittal said during an interview last week at the Behavioral Health Tech 2023 conference held in Phoenix.

To combat this issue, the insurer started a request for information process from potential health tech vendors, Mittal said. This process asked vendors specific questions about health equity, including if the company has ever served the Medicaid population before, how it drives engagement and what the company’s engagement rates were with Medicaid members.

“Using that, we’ve been much more mindful about how we bring in digital technology and how we think about those things. … Whether you can access education that’s in an app offline or whether you need a large amount of data to be able to access that information will differentiate whether you’re going to be successful with the Medicaid population,” Mittal said.

One example of a company that Health Net works with is Pair Team, which just secured $9 million in Series A funding. The company specifically works with Medicaid plans and partners with local community-based organizations, such as food pantries and shelters. Pair Team trains the staff of these organizations to become community health workers so they can provide care navigation services, health advocacy support and other services. Patients are then also connected with Pair Team’s virtual telemedicine team, which includes a registered nurse, nurse practitioner and behavioral health specialist. Another vendor that Health Net works with is Pyx Health, which offers an app that combats loneliness through chatbot and human support. If members don’t have a smartphone, they can work with the company’s staff over the phone.

Mittal’s comments about vetting digital health vendors come at a time when payers and employers are battling vendor fatigue. However, startups are often hesitant to work in the Medicaid space, and digital health companies that focus on Medicaid often struggle to get funding. Still, while many startups aren’t interested in pitching to Medicaid insurers (likely partially due to regulatory challenges), there are still quite a few that will, according to Mittal.

“I think we’ve just gotten more sophisticated at asking the right questions to really assess whether we’re going to be successful with a vendor. … Even in a sea of four or five vendors doing the same thing, once you really drill down, you’ll often find that there are one or two that are really going to meet the needs of a Medicaid population in an equitable way, that have been designed with equity in mind from the start,” she said.

Source: https://medcitynews.com/2023/11/medicaid-health-tech-vendor/