How Evidence-based Care Guidelines Support Medicaid Directors’ Top Priorities for Innovation and Reform

By Holly Toomey, MCG Director, Clinical Product Development and Innovation & Snapper Ploen, MCG Digital Marketing Manager

In December 2016, the National Association of Medicaid Directors conducted their 5th Annual Survey and summarized two pivotal, identifiable trends from the responses of 47 Medicaid programs:

  • Medicaid Directors are transforming the health care system from volume to value through innovation that reflects each state’s unique needs
  • Medicaid Operations are evolving to continue to drive program performance and support innovation

Specifically, state Medicaid Directors introduced state-based innovations in three key areas in 2016:

  • Value-Based Payment Reform: Implemented new payment models and population-based payments
  • Behavioral Health Innovation: Implemented managed behavioral health and behavioral health homes and integrated Mental Health and Substance Abuse at the provider level
  • Improvements in Long-Term Services and Supports (LTSS): Introduced methods of delivering LTSS in more innovative, cost-effective, and impactful ways, given that the number of elderly Americans is expected to more than double in the next 40 years

Targeted reform is already benefiting issues such as opioid prescribing practices, abuse & misuse as well as autism services. However, it is clear that more can be done through the leveraging of informed care strategies such as those being offered by MCG Health, part of the Hearst Health network.

In MCG’s recently released 21st edition of their evidence-based care guidelines, clinical decision support was enhanced in all content volumes to support both quality of care and appropriate utilization: this directly impacts value-based payment reform allowing payers and providers to focus on the entire arc of patient care, rather than just individual components of the care journey.

Through the Behavioral Health spectrum, MCG content includes guidelines to support patients in multiple levels of care, including substance abuse and treatment. Guidelines to help address the opioid epidemic in our country have been augmented with opioid use calculators, toxicology screening, assessment of use of pain medications, and patient education materials.

MCG guidance to assist clinicians and health plan physician advisors in the areas of autism was also strengthened to include: patient education on knowledge of condition and treatment plans; new guidelines for developmental language delays and speech disability rehabilitation; content addressing genetic testing as the basis for autism; social skills training; mental health support services; and ABA therapy.

MCG is continuing to find ways to improve Long-Term Services and Supports, but currently offers robust Chronic Care and Home Care Guidelines as well as Transitions of Care content volumes.

You can learn more on these topics and many others by downloading MCG’s complimentary white papers. Read more blogs by MCG here.

MCG Health, part of the Hearst Health network, helps health care organizations (in both the government and private sectors) implement informed care strategies that proactively and efficiently move patients toward health. MCG’s transparent assessment of the latest research and scholarly articles – along with data analysis – gives patients, providers, and payers the vetted information they need to feel confident in their care management decisions. Eight of the ten largest U.S. health plans and more than 1,600 hospitals use our evidence-based guidelines and software (Cite for Payers and Indicia for Providers). Learn more at MCG.com.

This article was created in collaboration with the sponsoring company and our sales and marketing team. The editorial team does not contribute.