Bringing Nashville's 'maker movement' to Medicaid

It wouldn't be surprising to see employees of Health ELT wearing shirts that read "#WhatAboutMedicaid."

The staff of Health ELT, an engagement and logistics technology firm, may not have those shirts yet, but given the level of devotion to a wonky program from people with non-health-care backgrounds, maybe shirts will come soon. And those shirts would probably be locally made and designed by a local artist.

Health ELT, centered in Dallas and Nashville, developed a digital framework that brings the traditional paper assessment used in Medicaid to determine how much care a person needs in homes or community settings out of the paper-pushing era to tablets and smartphones.

Amanda Havard moved to Nashville for college at Vanderbilt University about a decade ago and stayed. She is now chief innovations officer at Health ELT, which she co-founded alongside her dad, L. Cade Havard, chairman and CEO.

Now she's trying to bring technology to a corner of health care that, while massive, by her own admission as well as others', has lacked innovation. She's doing it with a team of people who have become devotees of Medicaid, whether they expected to be or not.

"This is a maker’s movement in Nashville … nobody in that room thought they were going to work on Medicaid nor did they probably even think they could be talked into it," Havard said. "It’s been fascinating to watch people whose expertise naturally lends itself to innovation come and apply it to a field that has traditionally lacked it. That’s why Nashville for me.”

Medicaid pays for the bulk of the long-term care, such as nursing home stays and in-home or community-based care, people with complex health issues need. Medicare covers windows of such services after hospital stays for people 65 and older.

In Tennessee, there are about 140,000 people dually eligible for Medicare and Medicaid.

Yet, the cost for the long-term support and services population is large. In 2014, the expenditures in Tennessee for seniors and adults with physical disabilities but not those with intellectual disabilities was more than $1.1 billion.

The physical forms leave room for problems, ranging from no easily tracked lasting record of assessment of care, to waste through inability to oversee the day to day of the people on the ground and potential scams.

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“Something that is very important to understand about these assessments — they don’t seem slick and sexy; they don’t seem like exciting technology — is that they have a huge impact on Medicaid spend in this country," Havard said.

There are many unknown variables in the day-to-day work of the home assessment, care providers and managers that get "purchased" by states, health plans or managed care organizations.

Health ELT is designing a mobile and Web-based app to streamline and simplify the process of determining who gets how much care. The technology looks more like a social network platform than an electronic medical record interface so it's easy to use.

"I imagine that (people will think with) technology, we’ll document everything and we’ll crunch some numbers and then we’ll say nobody needs that much care," Havard said. "That’s not at all what I’m trying to do. I’m really truthfully trying to make an accountable assessment process so if you do need all of that help then you get that."

The movement toward a tech-laden health care market used by tech-savvy consumers is underway. Smartphones track daily steps, and apps allow people to monitor everything from calories to blood sugar.

There are many companies and teams trying to bring technology to the people with complex health issues and who account for the most spending.

But Havard thinks Medicaid needs a brighter spotlight.

"What I know from a technology standpoint. ... They’re just not thinking about Medicaid because I don’t think they know that much about it," Havard said. "I’m nearly ready to start retweeting things and hashtagging #WhatAboutMedicaid."

Some states have expanded Medicaid to include the working poor under a restructuring of the program parameters in the Affordable Care Act. Tennessee has not because legislators on state Senate committees killed the Insure Tennessee proposal.

Tennessee's TennCare covers pregnant women, children and some people with disabilities.

"I do think it is an overlooked population. It worries me now that as we spend so much time and energy focused on innovation that we keep making tools to make the healthy healthier," Havard said. "We aren’t making tools, or at least we aren’t considering what we need to do to adapt these tools or define access to these tools, for the people who have problems in the first place. Who don’t wake up every morning counting their steps and drink green Smoothies.”

Don’t confuse demanding more attention to the program as a battle cry for expansion. Havard and her team want attention and accountability to the people in the existing programs by the agencies and firms in health care — whether states choose to expand or not.

“I’m going to serve no matter what happens. We’re going to keep going down this path,” Havard said. “No matter what happens we have to be better financial stewards of the money. I can help you document that. I can use data to make decisions, to prove how well someone is doing or how well they’re not.”

Reach Holly Fletcher at 615-259-8287 and on Twitter @hollyfletcher.