Enrollment in Medicaid managed care plans grew nearly 70 percent from 2007-2013, highlighting states' reliance on health plans that can improve outcomes for high-risk patient populations and save money in the process, according to a report from America's Health Insurance Plans (AHIP).
More than half of the 62 million beneficiaries enrolled in Medicaid were part of managed care plans as of 2013, according to AHIP, although more recent statistics indicate that as much as 70 percent of Medicaid beneficiaries are part of a private health plan. Since 2007, the growth of Medicaid managed care plans has nearly doubled that of overall Medicaid enrollment. As of 2013, 36 states plus the District of Columbia and Puerto Rico offered Medicaid health plans.
Keys drivers in the transition toward risk-based health plans are benefits offered to disabled and elderly beneficiaries. As opposed to the traditional fee-for-service Medicaid payment model, managed care plans emphasize a coordinated approach to integrated care delivery systems that can effectively manage chronic conditions and offer greater access to non-medical services, according to AHIP. In Massachusetts, Medicaid health plans exceeded quality benchmarks 83 percent of the time, compared to 43 percent in fee-for-service programs.
By emphasizing quality over quantity, managed care plans have placed more emphasis on disease management programs--including text-messaging outreach--which have reduced alcohol consumption and smoking rates among pregnant women and improved compliance with diabetes management, the report says. Research shows this approach can have significant cost savings, particularly when health plans include pharmacy benefits.
Despite the substantial losses incurred by many U.S. health insurers on Affordable Care Act policies, Medicaid plans have been profitable thanks to increasing enrollment numbers. However, some states are tweaking the traditional approach to managed care. Recently, Alabama elected to cut out for-profit insurers, instead choosing to work primarily with nonprofit provider organizations. Amid rapid growth nationwide, health experts have also cautioned that Medicaid must figure out how to acquire and compare data from managed care plan providers to ensure greater program accountability.
- read the AHIP report