opinion | Kate Walsh

Sustaining the achievements of Medicaid

Thursday marks the 50th anniversary of the national Medicaid program and the lifesaving access to health care it provides to millions of low-income Americans.

Five decades in, there is much to be proud of. Beyond improvements in health, there are significant long-term societal benefits, especially for the young children who comprise the majority of Medicaid recipients. Healthier children typically have improved behavioral and emotional competencies, better academic achievement and job opportunities, and reduced long-term need for social services. As significant as this impact is, we have real work to do to ensure these gains are sustainable.

It’s well known that Medicaid is one of the largest expenses in state budgets nationwide and a major challenge for states making tough choices about funding for other needed services like infrastructure, mass transit, schools, and community support programs — ironically the very services low-income citizens depend on. What is less well known is that the Medicaid program has long fostered innovation in our health care system, and that creates a significant opportunity to build a strong and sustainable Medicaid program for the next 50 years.


The cost challenges and political debate around Medicaid can overshadow the fact that these new models of care delivery have both improved the health of Medicaid patients and become industry standards that save the program money. Many innovations with the most impact have been practical, low cost, and low tech, addressing both tough medical and health care delivery problems as well as broader societal issues.

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By continuing to develop innovative new approaches, Medicaid providers can be an instrumental part of the solution to the current challenges the program faces. And because the Medicaid program cares for such a large portion of the population, it can have a tremendous impact on improving the health of our nation and on curbing the rising cost of our health care system. That is the real opportunity ahead.

At Boston Medical Center, more than half our patients are low income. We understand the importance of treating the whole patient and addressing the social determinants of health, including food and housing insecurity and exposure to community violence. In addition to being a safety-net hospital and academic medical center, our system, which includes the largest Medicaid health plan in Massachusetts and a network of 13 community health centers, provides a unique window into patients’ lives and a platform to improve health.

For example in 2003, caregivers at BMC created Project RED, a new model for discharging patients from the hospital in a way that promotes patient safety and reduces hospital readmissions — a problem that plagues the entire health care system. It is a prime example of a simple solution that works. Each patient receives an individualized, easy-to-understand color booklet on taking care of themselves at home. Included is information on medications, a color coded calendar of upcoming appointments and tests, an illustrated description of the discharge diagnosis, and information on what to do if problems arise. Together, these tools help patients navigate the time between hospital discharge and the first outpatient doctor visit, a critical period when inadequate information can trigger a recurrence of medical problems and readmissions. When hospitals use Project RED, they see an average 20 to 25 percent reduction in readmissions. Project RED is easy to use, inexpensive to implement and, most important, effective. That’s something we don’t see often enough in health care, as we more often turn to the latest gadgets and technologies when sensible inexpensive solutions may better help our patients.

As critical as Medicaid coverage is to millions of Americans and as much as we should applaud the program’s accomplishments, the next 50 years of Medicaid must look different from the first 50. Many states have expanded the program and access to needed care, an important first step. Now we have the chance for every stakeholder, from doctors and hospitals to elected officials and community groups, to work together to build a sustainable program for years to come that fosters practical, cost-effective solutions to difficult problems and excels at improving the health of the people it serves. The promise is not only better health for millions, but new techniques and innovations with broad applicability for the chronic ills of our health care system overall. If we take up this challenge, the next chapters in the history of Medicaid will be even more groundbreaking than the first.

Kate Walsh is president of Boston Medical Center.