Because Tech Isn’t For Poor People Anyways, Right?

Amanda Havard August 26, 2015

I work for a tech company that serves Medicaid.

A simple sentence that reads one part contradiction and one part complete mystery.

On the contradiction: No one in tech works with people or companies concerned with Medicaid.

On the complete mystery: In the last week alone, when explaining my work, someone asked if Medicaid and Medicare were the same, someone else if Medicaid was invented by the ACA, and a third asked, “but Medicaid’s not a thing anymore because of Obamacare, right?”


There are few key things to know and understand about the scale of Medicaid and, thus, the largest untapped market for tech:

  • The US spends roughly half a trillion dollars a year on Medicaid each year, which exceeds the annual out of pocket medical expenditures of all Americans combined.
  • That number is growing. With expansion, some predictions expect a 15% growth spike in 2015. Conservative estimates predict at least 6% annual growth for the next decade.
  • Nearly one in every four Americans is on Medicaid.
  • Medicaid is the world’s largest health plan. If it were a country of its own, American Medicaid’s pre-expansion population would greatly exceed France’s total population.
  • Kids are a huge part of Medicaid. 70% of babies born in the state of Louisiana are born on Medicaid. In the state of California, roughly half the population under 20 is on the state’s $95 billion-a-year Medicaid program, Medi-Cal.
  • No two states share the same policies, structures, requirements, assessments, or benefits to its members. In most cases, no two health plans in the same state share these things.
  • People on Medicaid are hard to find — as in physically locate and communicate with. Anecdotally, the industry-wide figure for engagement is around 40%. Consequently, the number of low-income adults over 50 receiving adequate preventative care is reported as low as 21%.
  • Once located, there is an extensive, complicated set of paper forms that have to be completed, calculated, and typically data-entered, depending on the population and patient need. These records typically aren’t saved in any usable format. The data isn’t minable or searchable. Being able to see a patient’s progress or decline from year to year is impossible in many — likely most — places.

Meanwhile, those of us who work in tech companies can’t get enough of our health. We swear by supplements, drink green smoothies every morning, and use apps to monitor vitals. We track our 10,000 steps. Now, we even track our dogs’. We make health a priority, and in many ways we use technology to do it.

Which is lovely. But this mHealth fascination illustrates an interesting point. You and I and Fido have a FitBit. We are healthy and getting healthier.

What do America’s poorest, often sickest people have?

It’s abundantly clear that many of the problems — both health-related and simply logistic in nature — facing Medicaid and America’s poorest could be solved or smoothed using technology. And yet shockingly few tech outlets, legislative, or economic journals ever seem to discuss this rampant population. Too few influential entities are paying mind to such a critical space.

In the tech world, among largely privileged, connected, and savvy entrepreneurs poised to actually make sure real technology reaches real hands that have real need, we aren’t reaching these populations — and even organizations — in need. How many companies, like Health: ELT, dedicate themselves to diving in, trying to figure out this population’s specific needs? How many companies who have UX staffs spend time figuring out the path to better UX of a Medicaid-form-that-looks-like-a-tax-form (and is equally insane to fill out)?

Why is there such a disconnect between technologists and populations in need?

Since I left mainstream digital tech projects and arrived square in the middle of public health, I’ve learned an incredibly valuable lesson:

Technology existing and technology getting into the hands of the people who need it most are entirely separate things.

This couldn’t be truer than in the current techosphere, and it couldn’t be more important than in the current mHealth fascination. The key is simple: We need to improve the worst parts of healthcare. Sometimes that’s going to be as slick as a contact lens that monitors blood glucose levels for diabetics. Sometimes that’s going to be as boring as giving people a better way to fill out forms — more mobile apps and less clipboards — so they can later have a better way to evaluate a patient’s records cohesively, make tough decisions, and stay accountable to patient need. We need both the slick and the boring. We need to be creating both for everyone.

In the time I’ve worked in an organization making tech for the people on Medicaid, and for the companies and state agencies who serve them, I’ve found an industry thirsty for innovation. Even the federal government echoes this, willing to support any exploration into innovative approaches to healthcare administration programs for these populations to the tune of hundreds of millions of dollars.

The American poor deserve to reap the benefits of technology and innovation. And for those creating technological, innovative solutions, we find ourselves with the rare chance to make products that could have real legislative, economic, and human impact, to make companies that create good as much as they can create profit.

So why aren’t we?