Enhancing Medicaid Programs and Payment Systems

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The chapter delves into the challenges and program integrity issues faced by Medicaid, spotlighting the Adult Day Care service and a new dementia benefit. It discusses the importance of incentivizing providers, revenue maximization, the shift to value-based payment models, and initiatives to address unmet healthcare needs. Additionally, it explores innovations in maternal health, substance use treatment, and outcomes-based reimbursement in healthcare.

This episode is part of Pear VC's series on Medicaid, covering the basics that founders need to know to build innovations that support communities in need.

Today, we're excited to get to know Eliot Fishman, a director at CMMI who focuses on policy and programs that affect Medicaid beneficiaries.

Eliot comes to us with a long history of impact in public health policy. Eliot started his career as a policy associate at Mt. Sinai Health System in NYC and then went on to Manatt, Phelps & Phelps. He transitioned into a management policy role on the provider side again at MJHS, a large health system in the New York Area before he left to join the government.

Eliot then served at NJ Department of Health and Senior Services and Centers for Medicare and Medicaid Services for several years across different groups on Medicaid, Medicare and CHIP. Eliot also served in consulting roles at Health Management Associates and at nonprofits like Families USA.

In this episode, we learn about payment models within CMMI that attempt to foster innovation in care delivery for Medicaid, program and payment integrity and value-based care models as well as how the Federal government collaborates with State governments to improve care delivery.