The Medicaid Transformation Project, founded by the health system network Avia and former Centers for Medicare and Medicaid Services acting administrator Andy Slavitt, released its Phase One report this week after two years of operation. 

30 health systems and the Veterans Health Administration are MTP members, comprising 378 hospitals in 28 states. 

Phase One focused on evaluating where evidence-based care models can intersect with digital solutions. 

“At the conclusion of Phase One, over 150 new actions are being implemented to improve care for moms and babies, people with mental illness, and those who need care brought closer to them. These actions have either been launched through or accelerated by participation in the MTP community,” according to the report.

Nearly three-quarters of all actions involved using technology in new ways.

“We deliberately took an evidence-based care model approach to this work by emphasizing technology solutions with the critical competencies for removing barriers to these models’ financial sustainability. To that end, we have seen well over 100 instances where a specific technology was adopted to improve these care models and ensure their long-term existence for communities who desperately need them,” MTP Executive Director David Smith told Healthcare IT News.

“There are a range of examples, from [admission, discharge and transfer] systems to contingency management solutions for patients in recovery from [substance use disorder],” Smith continued. “What’s most important is that each approach was uniquely crafted and is highly germane to the community itself.”


The MTP report explained that Phase One’s campaigns focused on frequent challenges experienced by health systems: emergency department utilization, behavioral health, substance use disorder and maternal and infant health.

Of the 150 actions undertaken by health systems, nearly one-quarter involved constructing coordinated care networks; 19% enhanced maternity care navigation; 17% built or advanced a community health worker program; 7% expanded substance use disorder recovery management; and 6% created behavioral health integration.

The report highlighted the efforts of Advocate Aurora Health in Illinois and Wisconsin, which began using the Babyscripts software toolkit to address the pre- and postpartum care needs of more than 8,000 patients, with 85% patient satisfaction.

“Advocate Aurora also implemented a remote monitoring component, which allows low-risk women to monitor their blood pressure at home and send vitals to their care team, potentially decreasing the number of prenatal appointments,” the report showed.

According to MTP, more than 10,000 blood pressure points were collected and provided to clinicians; the system is now scaling up the software with help from the organization.

While Phase One built a foundation for health system action, Phase Two “will leverage this work to support providers in partnership with payers to develop these models in markets across the country,” read the report. 

The goals include expanding the network, supporting demonstration projects, reducing barriers to action in key focus areas, launching new campaigns such as chronic disease management, and helping members identify and address the most pressing priorities.


Smith told Healthcare IT News earlier this year that the pandemic has driven the initiative’s leadership to expand its focus. According to Smith, MTP has broadened its definition of “vulnerable population” to include elderly people, those with chronic illnesses, people experiencing domestic violence, healthcare frontline workers and others.

“Accordingly, we’ve expanded the aperture of our work with our members and digital health companies to address these populations,” Smith explained.

Smith also told Healthcare Finance News in 2019 that by working together, health systems can maximize their knowledge base and share potential solutions. 

“We’ll identify key areas of opportunities by providers and look at, ‘Where did we already solve for this in a patient engagement way?'” Smith said.


“When we began the Project, we knew that we could impact individual patient lives immediately but that permanent, systemic impact would require more time and a combination of solutions. COVID-19, financial hardship, and emphasized evidence of racial disparities have only heightened the imperative to act decisively for the vulnerable, communities of color, and the health systems that seek to support them,” said Slavitt and AVIA President Linda Finkel in a letter introducing the report.

“While this transformation is hard work, we’ve seen an incredibly positive effort emerge and can already say with confidence: it’s working. We are on the path to meaningful change and the country must continue its progress,” they continued.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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Medicaid Transformation Project releases Phase One report – Healthcare IT News