Outgoing Texas Medicaid director says managed care plans demonstrate promise

The former director of Texas' Medicaid programs believes managed care plans are well placed to help meet the needs of Medicaid enrollees.

Kay Ghahremani, former director of Medicaid programs for the Texas Health and Human Services Commission, talked about the promise of managed care plans and trends in the healthcare industry in an interview with the Houston Chronicle. Ghahremani will become CEO of the Texas Association of Community Based Health Plans (TACHP) in January.

"Medicaid managed care plans are primed and have greater experience working with a population that has a broader range of needs than typical commercial populations," Ghahremani told the newspaper.

Texas is currently negotiating with the federal government to renew its 1115 waiver that allowed the state to move Medicaid enrollees into managed care plans. The waiver will allow Texas to continue its current managed care program, Ghahremani said. She expects the waiver, which expires in 2016, will be renewed with perhaps some modifications. However, if it doesn't receive approval, the state would pursue other avenues for federal approval to continue its program.

In her new job at the TACHP, Ghahremani will work with 11 nonprofit safety-net health plans. One of her goals is to help those health plans engage community providers since some doctors have been reluctant to sign up with Medicaid plans in Texas.

Changes in the healthcare industry are creating new possibilities, she said. "It's no longer just about making sure somebody can get into a doctor's appointment, it's now about making sure they get to the right provider, they get the right services, they're not getting unnecessary procedures, and making sure they get preventative care and stay out of the hospital. Those have not been goals of the healthcare environment in the past."

The change requires a mindset shift among providers, and health plans must build a good relationship with providers in their communities, she said.

The quality, cost and accountability of Medicaid managed care are the three primary reasons states to turn to such arrangements, according to America's Health Insurance Plans experts. States that want their programs to better serve the growing ranks of Medicaid enrollees should look to some of the innovation solutions employed by Medicaid managed care organizations, according to a new white paper from the Anthem Public Policy Institute.

To learn more:
- read the interview