Survey of Medicaid directors shows innovations in state programs

Some of the biggest shifts and improvements in government healthcare programs may be happening at the state level, according to a new survey.

In 2015, nearly 60 percent of Medicaid directors across the country spent half or more of their time working on major payment, delivery system or programmatic reforms, according to a survey by the National Association of Medicaid Directors.

While a top priority of those directors over the last several years has been implementation of the Affordable Care Act, many directors say they plan to turn their attention to other reform goals in 2016. The fourth annual survey of directors shows a Medicaid program that continues to "evolve, improve and innovate at a rapid pace," according to a report from the nonprofit association that represents leaders of state Medicaid agencies across the U.S.

Here's what the survey showed:

  • Payment and delivery system reform is at the top of Medicaid agency innovations.
  • Agencies are moving to performance-based reimbursement models within both traditional fee-for-service care delivery and managed care.
  • High priorities for states include patient-centered medical homes, health homes, alignment of physical and behavioral health, super-utilizer programs and population health.
  • Top issues for four-fifths of the agencies include managed long-term services and support and managed behavioral health programs.

Federal programs designed to improve population health include the Pioneer ACO program, the Bundled Payments for Care Improvement and the Medicaid Shared Savings Programs. While innovation is also taking place at the state level, most directors cite factors such as limited staffing, data and systems infrastructures, administrative budgets and complex procurement processes as barriers to innovation.

As FierceHealthPayer previously reported, one such innovative program is taking place in New York, where Medicaid officials are investing more than $1 billion in a five-year program aimed at transforming how providers coordinate to take a more active role in caring for members' health.

While they take on more responsibilities, director salaries remain flat, according to the survey. About two-thirds of Medicaid agency chief executives earn between $100,000 and $150,000 a year. That's a factor that may hurt the Medicaid program's success, as one report suggested states should review program directors' compensation levels, which do not compare with salaries of top health insurance executives.

To learn more:
- here's the survey results