Strategic brief

Addressing the Medicaid opportunity for
Honest Health's health system partners

Honest Health's health system partners are experiencing disproportionate financial and operational strain from their Medicaid populations. Unlike existing value-based arrangements, this population sits outside current risk-sharing structures. This brief outlines a disciplined approach to developing a service offering that leverages Honest's existing capabilities — creating clear value for partners and a scalable revenue opportunity for Honest.
Prepared for
Honest Health leadership
Status
Working draft — for discussion
Date
June 2026
Health system partners
Banner Health — Arizona PeaceHealth — Oregon / Washington Albany Med — New York
Step one
Opportunity assessment
Before designing interventions, we must understand the shape of the opportunity in each market — first by listening to partners, then by quantifying what the data shows.
Phase 1 — Partner discovery
Structured listening with health system leadership before any analysis begins

What feels urgent to Banner Health may be entirely different from what PeaceHealth or Albany Med is wrestling with. Until we understand what each partner is trying to solve — in their words, with their data — we are guessing at what matters. Three questions anchor every partner conversation.

Patient attribution
How many Medicaid members are actually attributed to this health system vs. seeing community or competing providers? Attribution determines leverage, capacity for intervention, and the addressable population — and reveals what community capacity exists to redirect patients to alternative care sites.
Financial pain points
Where is the Medicaid population creating the most strain — ED overutilization, uncompensated care, readmission penalties, margin compression? The answer shapes which interventions to prioritize and what Honest can charge for solving them.
Partner priorities — which patient segments to address first
The Medicaid population is not monolithic. Six distinct member segments each require different interventions and carry different financial implications. Partners must identify which segments they want to address — and what they are willing to fund — before solutions are designed.
Phase 2 — Opportunity quantification
Data-driven sizing of the opportunity, framed around what partners identified as most urgent

Quantification serves three purposes simultaneously: it tells the health system the size of the opportunity they're leaving on the table, it gives Honest a basis for pricing its services, and it creates the financial justification for the health system to allocate budget.

Population profile
Who are the Medicaid members attributed to this system? How many, by segment? What is their condition burden, utilization pattern, and geographic distribution?
Financial quantification
What is the margin impact today? What is the dollar value of avoidable utilization, uncompensated care, and unrealized quality revenue? What can Honest reasonably charge to address it?
Six population segments — each requires a distinct intervention
A
Coverage gap
Uninsured but likely Medicaid-eligible. Converting uncompensated care to covered care is a direct margin improvement.
B
Healthy women & children
High volume, low complexity. The opportunity is reducing cost-to-serve, not volume.
C
Medically complex
Small cohort, disproportionate cost. High concentration makes targeting financially significant.
D
Disengaged chronic disease
ED as primary care. Re-engaging these patients generates measurable savings.
E
Access-limited
Rural or geographically isolated. Telehealth and community-based care reduce cost-to-serve.
F ★
Managed Medicaid
MCO resources exist but are underutilized. Starting point for most partners — unlock what the payer has already funded.
What this assessment produces
For the health system
A clear picture of their Medicaid population — who they are, what they cost, and what's addressable — in terms the CFO and CMO both recognize.
For Honest's pricing
A quantified opportunity that anchors what Honest can charge — fee tied to addressable value, not an arbitrary number.
For intervention design
A prioritized segment map that determines which populations to address first and in which markets.
Step two
Intervention framework
Four categories of intervention — one foundational requirement and three strategic plays. Outreach and engagement capability must be confirmed before any other intervention can succeed.
Foundational — Outreach & engagement capability
Prerequisite for every downstream intervention

Every intervention in this framework depends on the ability to reach and activate Medicaid members. Without that capability, downstream programs underperform regardless of design. Two questions must be answered before any program is committed to.

What exists today
What outreach capabilities do Honest and its partners currently have? Texting platforms, care navigation staffing, patient communication workflows, nurse advice lines — what is already deployable without new investment?
What gaps need to be filled
Where are the gaps, and what is the most cost-effective path — build, borrow from a partner, or procure? SMS is the primary digital channel for Medicaid populations. Care navigators and nurse lines are the primary human channel.
Administrative plays — OBBBA readiness
Near-term service opportunity created by federal Medicaid policy changes effective January 2027

The One Big Beautiful Bill Act (signed July 2025) creates two significant administrative burdens for health system partners beginning January 2027. Both represent a concrete, near-term service opportunity for Honest — and a reason for health systems to engage now rather than wait.

Work requirements
Community engagement compliance
Medicaid expansion adults must demonstrate 80 hours per month of work, community service, or education to maintain eligibility. Health systems will see members lose coverage — and return as uninsured patients generating uncompensated care.
Honest opportunity: identify at-risk members, connect them to qualifying activities, and navigate compliance before coverage is lost.
Redeterminations
Eligibility churn management
Eligibility reviews shift from annual to semi-annual, creating significant member churn. Members who fail redetermination return as uninsured patients — increasing uncompensated care at the exact moment health system margins are already under pressure.
Honest opportunity: build a re-enrollment support process that converts lapsing members back to covered status before they hit the ED without insurance.
Revenue plays
Leveraging Honest's existing capabilities to generate new revenue for health system partners

Both plays leverage capabilities Honest has already built in its REACH and MSSP programs. The investment required is extension, not construction from scratch — which is precisely what makes them viable in a non-downside-risk arrangement.

Revenue play 1
Pay-for-performance with MCOs
Negotiate P4P contracts with managed Medicaid plans tied to quality metrics, utilization targets, or population health outcomes. Creates a revenue mechanism for health system partners without requiring downside risk.
Honest advantage: existing MCO relationships and contracting experience from REACH and MSSP are directly transferable to this model.
Revenue play 2
Risk adjustment optimization
Ensure accurate documentation and coding for managed Medicaid members to capture appropriate capitation rates. Particularly high-value in Oregon, where the concurrent risk adjustment model generates in-year returns — not a 12-month lag.
Honest advantage: existing risk adjustment infrastructure from MA and REACH. Oregon's concurrent model makes the ROI case faster and cleaner than any other market.
Expense plays
Reducing cost-to-serve by getting patients to the right setting at the right time

The core logic of every expense play is the same: reduce unnecessary high-cost utilization by connecting patients — particularly those generating negative-margin encounters — to more appropriate, lower-cost settings.

  • Redirect patients to primary care and community providers
    Connect members with negative-margin encounters to PCPs or FQHCs rather than the ED. Map the network of community health centers and alternative sites in each market first — understanding community capacity is essential before redirecting volume.
  • Expand virtual care and nurse line access
    Telehealth and nurse advice lines provide a lower-cost alternative to ED visits for low-acuity conditions. Particularly relevant for rural and access-limited populations where geography is the primary barrier.
  • Deploy advanced practice providers
    Leverage NPs and PAs for appropriate Medicaid patient encounters. Reduces cost-to-serve without reducing access or care quality.
  • Care navigation and referral coordination
    Dedicated navigation resources help members find the right care in the right setting — reducing avoidable utilization while improving patient experience. Model: St. Elizabeth Healthcare Nurse Now program.
  • Help patients leverage MCO benefit plans
    Identify staff or a structured process to help managed Medicaid members understand and use benefits their MCO has already funded — reducing unnecessary health system utilization by connecting members to payer resources they may not know they have.