Molly Manuse, GB’19, completed her Capstone Project with The Health Wagon, a nonprofit that provides healthcare to thousands of people in rural southwest Virginia. 

“I knew my work would have a significant impact on the future of an organization,” Manuse said.

Dr. Teresa Tyson, executive director of The Health Wagon, applied for a Capstone Project in which a Richmond MBA candidate would help the organization solve a strategic challenge. In May 2018, Virginia’s General Assembly voted to expand Medicaid under the Affordable Care Act. An estimated 98 percent of The Health Wagon’s patients qualified for Medicaid with an income at or below 138 percent of the federal poverty level. Leaders at the nonprofit needed to determine how the expansion would affect their free clinic operation, and decide whether they should adopt a new business model that would allow them to accept Medicaid.

Manuse did extensive research into how Medicaid expansion had impacted low-income patients and the nonprofits serving them. “I reviewed dozens of academic studies which had been published during the years following the Affordable Care Act, when 32 other states expanded Medicaid. I reconciled the published findings with the Health Wagon’s own data to develop multi-year forecasts for different business models,” Manuse said.

“For patients who either lack health coverage completely or cannot afford their deductibles, free and charitable clinics are a crucial safety-net to receiving essential healthcare services,” Manuse wrote in her Capstone Project presentation. “In other states, nonprofits had to decide between honoring their mission in being the safety-net for the medically underserved, or changing their business models to accept Medicaid, potentially reach more low-income patients, and serve a gap that many private practices do not adequately address.”

In order to remain successful, Manuse knew The Health Wagon needed a strategic plan to navigate the Medicaid process. In her Capstone Project, she outlined the potential impacts of Medicaid expansion in the State of Virginia in relation to The Health Wagon’s free clinic operation.

“I learned that it’s not all about the numbers, it’s about understanding your clients and understanding their priorities,” Manuse said. “If The Health Wagon suddenly decided to discontinue serving patients who enrolled in Medicaid, it’s very likely those patients would experience a lapse in healthcare due to Medicaid capacity constraints at physician offices.   They didn’t want to further limit patients’ access to services.”

Manuse worked closely with Rachel Helton, director of development for Health Wagon, during the project.

“Molly continuously went above and beyond for this project,” Helton said. “She researched every detail and worked with our state partners to ensure that she would give us the best possible recommendation.”

Since working with Manuse, The Health Wagon made the decision to remain a free clinic but to create a new entity that will accept Medicaid, Medicare, and commercial payers.

“That new entity is going through the incorporation/credentialing processes,” Helton said. “I constantly refer back to her project and data for strategic planning purposes.”

Manuse believes she got a unique experience working with a nonprofit in her Capstone Project, as it gave her the chance to make a difference in the community the Health Wagon serves.

“I had to think about how I can help The Health Wagon be solvent and continue carrying out their mission of serving the community,” Manuse said. “I learned so much about a really complex topic.”