Rachel Dixon (she/her) is the CEO of Prime Health, a Colorado-based nonprofit focused on advancing health equity, quality, access, and cost through innovation, collaboration, and community building.

Prime Health focuses on driving innovation to support communities that have historically been marginalized or underserved, such as people with low income, who are Black, African American, Latinx, American Indian, Asian, Middle Eastern, or Pacific Islander, who have disabilities, are LGBTQ+, or who are living in rural areas.

April is Medicaid Awareness Month, and here, Rachel shares insights from over a decade in the Medicaid innovation and digital health space, offering advice — and a call to action — for all health solution innovators.

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Check out these resources to help your health solution or organization learn more about Medicaid.

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In Full Health (IFH): What sparked your interest in health innovation — and specifically health solutions for individuals on Medicaid?

Rachel Dixon: I grew up in rural — very rural — Arizona. We’re talking dirt road, middle of nowhere rural, and the closest hospital was about an hour’s drive away.

In Arizona, I had the privilege of working in the social justice and community organizing space. I worked with rural communities, refugees, migrants, foster care, and people who had experienced gender-based violence. We were working to tackle issues of human trafficking, human rights, homelessness, mental health, and maternal health.

Something that kept coming up over and over in everything I did was health — different barriers to health, needs relating to health, health equity and disparity issues, and discrimination in health care.

This got me interested in the common thread health and health care played in other structural and systemic issues. I saw over and over how not having access to the right care at the right time could harm a person. I also saw over and over how health care services can and do work when done well, and how much a person can heal with access to support.

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IFH: What are some of the biggest challenges faced by people who are on Medicaid?

Rachel Dixon: When we’re talking about somebody on Medicaid, we’re talking about somebody who’s living at or below the poverty level. To put that into context, in Colorado the income limit to qualify for Medicaid as an individual is $20,120 a year (or less than $1,700 a month). Twenty-five percent of Coloradans are on Medicaid — that’s 1 in 4 people.

Poverty is inextricably tied to structural, systemic, and institutional oppression. In other words, Native Americans, Black Americans, transgender Americans, and gay or lesbian Americans are significantly more likely to experience poverty than white, heterosexual, cisgender Americans. Poverty is also directly linked to worse health because of things like fewer grocery stores in poor neighborhoods or less access to clean, safe water and air, to name only two of many examples.

I say all this to ground us in an understanding of what “being on Medicaid” means, and the realities of the other factors contributing to health and health access.

It can be hard to take time off work. Going to the doctor often means losing a shift and losing money. You may not be able to afford childcare during your appointment. You may not have a car. We have clients for whom it can take 4 hours on the bus each way to get to their appointment.

You might literally have to choose between going to work so you can feed your family and keep your house or going to the doctor. Even if a person on Medicaid isn’t paying for their care, there is still a significant cost to them to get to that appointment and to have the time for that appointment.

The Medicaid system itself, while not perfect, is highly effective. However, there is a lot of ignorance and widespread myths and beliefs held about Medicaid patients and the Medicaid system. For example, many people still believe Medicaid is a welfare system for the unemployed, when in fact 65% of people are from working families. Or that you can’t innovate in Medicaid because of patient digital literacy yet 86% of Medicaid beneficiaries have smartphones — the same rate as the general US adult population. Medicaid systems have a long history as early adopters of telemedicine and digital health policies and reimbursement.

But given the constraints and complexities of how Medicaid is structured, there are unique challenges that ultimately end up impacting the patient. These include bureaucratic and administrative things like:

• The reimbursements to health care providers are often lower than private insurance, which means some providers — especially specialists — are incentivized to focus on commercial patients, which can limit access for Medicaid members
• Patient-provider attribution
• Uncoordinated and siloed data repositories and systems
• Complex and varying reimbursement models and rates

All of these can discourage providers from wanting to accept Medicaid insurance. This contributes to provider workforce shortages and care coordination problems in Medicaid. It leads to limited provider options, longer wait times, and less scheduling flexibility for Medicaid patients (who actually probably need shorter wait times and more flexibility than someone with a high income, salaried job with childcare, and paid time off).

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Expressing Gratitude

I want to thank the Colorado community and the safety net providers of America. The level of dedication, compassion, creativity, and intelligence is extraordinary. I love our safety net provider community, our Medicaid community, our patient advocates, our grassroots organizers, our innovators and entrepreneurs — our entire Colorado community. I’m so proud to be a part of it.

Rachel Dixon
CEO, Prime Health

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IFH: What are some of the biggest opportunities for health solution developers when it comes to working in the Medicaid space?

Rachel Dixon: There are a lot of myths and biases about what it means to be a person on Medicaid and about the Medicaid program in general. There’s this pervasive idea of, “We don’t want to work in the Medicaid space because Medicaid is for poor people,” “the patient population is too difficult and we won’t see the outcomes or results we’re hoping for,” and “You can’t get paid in Medicaid. We can’t make any money. We can’t grow or scale.” That is incorrect.

When you combine the 25% of Americans that are Medicaid beneficiaries with the 9% of Americans that are uninsured, that’s 34% of the American population being served by the Medicaid health care system and providers — what we call the safety net. That’s simply a lot of people. If you’re only focused on the commercial or privately insured health space, you are seriously and significantly limiting your Total Addressable Market (TAM). Medicaid also tends to be a less saturated market, or a bluer ocean, than the commercial space.

Collectively across the US, there are billions of dollars in funding for Medicaid-focused innovation. This opens up new pathways and alternatives for solution developers beyond seeking investment dollars and giving up equity shares. Federal and state governments, Medicaid payers, Medicaid providers, and Medicaid patients want innovation. I also see trends of health care partners being more willing to try early-stage solutions and pilot something if they believe it has the potential to make an impact on their population and their goals with less red tape than what I’ve seen in large commercial systems.

For example, we have a program called the Prime Health Innovation Challenge that allows the health care community to identify solutions that have the potential to make an impact on Medicaid systems and populations. We then support those solutions in finding pilot partners and funding those pilots. Our program has an 87% success rate in matching solutions and health care pilot partners within a year, and our average contracting time is 4 to 6 months. Nationally, the average time to get through contracting for a partnership is 1 to 2 years.

IFH: How can developers better design their solutions to work for Medicaid populations?

Rachel Dixon: We as a community are designing the future of health care and health systems built on technology. We have an opportunity to collectively design better systems and structures. We can learn from past mistakes we made by not designing inclusively or thoughtfully.

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It is imperative that we design a human-centered, inclusive, accessible, sustainable, and strategic future that specifically focuses on addressing digital equity and inclusivity.

Rachel Dixon
CEO, Prime Health

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So, where do we start? We can’t know everyone’s lived experiences — but we can actively work to include them. There are incredible leaders in every one of these spaces — community organizations, advocacy groups, patient advocates, patient-owned co-ops, educators, and human-centered design experts. We can collaborate with them, hire them, listen to them, learn from them, and support them. We can think about the diversity of perspectives in our leadership teams and on our advisory boards and set goals and metrics to be accountable to.

But as a basic starting point to answer your question, at a minimum, all solutions should consider the following key areas in their design:

• Diversified and inclusive data sets, especially for artificial intelligence solutions
• ADA compliance for software and technology
• Preferred language inclusivity
  • Reading and literacy levels, and standards for English speakers
  • English and Spanish at a minimum
• Digital accessibility for:
  • Low internet bandwidth areas
  • Older devices
  • Older operating systems
  • Limited cellular data plans
  • People who have internet access but no cell service (e.g., Does your solution require an SMS to verify?)
  • User-preferred solutions like Whatsapp or phone calls
• Diverse representation and inclusion in branding, imagery, and marketing materials
• Inclusive language regarding race, ethnicity, gender, and sexual orientation
• Professional and respectful language regarding diagnoses, conditions, and other lived experiences

We also have to consider the lived experience of the providers as your customers. If you want providers or health systems or payers or state partnerships to choose your solution, you need to be able to answer questions like:

• Have you learned about the different types of organizations in Medicaid and what they mean? An FQHC, for example?
• Does this workflow work for a provider?
• Do I have a plan for EHR integration that is as easy and cost-effective as possible for the provider?
• How will a provider pay for this solution or make this solution sustainable? What about my solution is reimbursable? What quality or incentive measures could I impact?

This is all stuff your customers and users are thinking about. So, if you’re not thinking about it, you’re missing out on an opportunity.

IFH: Prime Health will be hosting the 10th Annual Colorado Health Innovation Summit this year. What do you love about this event, and what kinds of things have you seen come out of it?

Rachel Dixon: This year, the Colorado Health Innovation Summit will be held May 18-19 in Denver, Colorado. It is a place to explore themes of equity-driven innovation, digital health solutions, public-private partnerships, equity, quality, access, and cost.

The Summit brings together a range of players and ecosystems, including federal representatives, community-based organizations, patient advocates, digital health entrepreneurs, and investors. It’s a great opportunity for networking and connecting. Some of the most authentic conversations you’ll hear in health care are at this conference. We work with thousands of organizations across the country and in Colorado — and it is a beautiful community. No matter what your role is in health care or health innovation, you’ll find something here to inspire you.

IFH: How else can health solution innovators get involved with Prime Health?

Rachel Dixon: If you care about health equity, Medicaid, and innovation, there’s a place for you. Reach out to us. We love talking to people and connecting you to the network and tools to better serve the Medicaid community.

We know that innovation and technology are powerful tools to improve health and address many barriers to health and health care. We strive to ensure that those who most need and would most benefit from innovative, thoughtful approaches are centered and uplifted rather than left behind and left out.

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