AHIP experts weigh in on value of Medicaid managed care

What's the value of Medicaid managed care, and how is it faring? To find out, America's Health Insurance Plans recently asked three of its Medicaid policy leads. 

The quality, cost and accountabiliy of Medicaid managed care are the three primary reasons states turn to such arrangements, said Mark Hamelburg, AHIP's senior vice president of federal programs.

"Medicaid health plans successfully address the needs of beneficiaries while coordinating care in ways that state-administered Medicaid fee-for-service programs do not," Hamelburg said, adding that states hold plans accountable by publicly reporting performance outcome measures, requirements for quality improvement programs and network adequacy standards.

The article also outlined the outcomes and costs associated with managed care. Georgia, Washington and South Carolina see better treatment options for children, mental health and substance abuse, and adults with diabetes, respectively, in Medicaid managed care programs compared with fee-for-service programs, said Howard Weiss, AHIP's vice president of public programs policy. These findings are similar to recent research from the Anthem Public Policy Institute, which found that Medicaid managed care organizations (MCOs) typically outperform Medicaid fee-for-service plans on key clinical quality metrics.

Medicaid also helps the part of the population that has non-health related needs, according to Randy Desonia, AHIP's executive director of Medicaid policy. When Medicaid designs its care management programs and service delivery networks, it includes activities that improve everything from nutrition to transportation opportunities, he says.

MCOs have recently been working to standardize data collection that would provide better care based on real outcomes, FierceHealthPayer has reported. Though about 74 percent of Medicaid enrollees are part of an MCO, standardized encounter data are scarce for the populations these programs serve.

To learn more:
- here is the AHIP article

Suggested Articles

Hospitals are already signaling a legal challenge to a final rule from CMS on price transparency, but the agency is ready.

CMS issued a proposed rule and a final rule aimed at increasing price transparency from hospitals and insurers.

Medicare Advantage insurers are eyeing loneliness as a crucial social determinant of health to target.