Medicaid Health Plan Community Partnership Series
April 17, 2013
The Commonwealth Fund
As state Medicaid programs are increasingly shifting beneficiaries into managed care organizations (MCOs), some MCOs are expanding their traditional role to better meet the needs of their vulnerable members and communities.
In a new Commonwealth Fund report, Health Management Associates Managing Principal Sharon Silow-Carroll and Consultant Diana Rodin, report on the efforts of four managed care organizations (MCOs) that are forging community partnerships to meet the needs of vulnerable Medicaid patients and others in their communities.
They developed four case studies:
These case studies describe the "how" and the "why" when it comes to MCOs addressing barriers and changing the way care is delivered, including internal and state policy drivers, leveraging partnerships and key take-aways.
April 12, 2013
AARP Public Policy Institute; National Association of States United for Aging and Disabilities
Jenna Walls, BS Public Health | Senior Consultant | Contributor
Authored with: Wendy Fox-Grage and Kathleen Ujvari of the AARP Public Policy Institute; and Diana Scully, Eunhee (Grace) Cho, John Michael Hall of the National Association of States United for Aging and Disabilities
This report finds that two-thirds of the states either have or will launch new initiatives to better coordinate care for people who are dually eligible for Medicare and Medicaid services, the so-called "duals," over the next two years. To contain the growth of costs and improve care, many of them are moving to risk-based managed long-term services and supports models.
March 29, 2013
Tony D. Rodgers | Principal | Contributor
Margaret Kirkegaard, MD, MPH | Principal | Contributor
Meghan Kirkpatrick | Senior Consultant | Contributor
A template for helping states transform their healthcare delivery systems.
March 20, 2013
AARP Public Policy Institute
Wendy Fox-Grage, AARP Public Policy Institute
Jenna Walls, Senior Consultant, Health Management Associates
The vast majority of people who need long-term services and support want to live in their own homes and communities as long as possible. States have made progress in providing greater access to home and community-based services (HCBS) for people with low incomes.
This research collected state studies about the cost effectiveness of HCBS. The 38 studies, published from 2005 to 2012, include state-specific analyses by public and other organizations. Major findings include:
- The studies that evaluated the cost effectiveness of HCBS supported Medicaid balancing and other efforts to move more resources toward home and community services rather than institutional care.
- The studies consistently showed lower average costs per individual for HCBS compared to institutional care. In California, for example, spending on nursing home care per person was three times higher than for HCBS—$32,406 for nursing facility care versus $9,129 for HCBS in 2008.
- The findings show cost reductions by diverting people from nursing home care to HCBS. In Nevada, the monthly average number of older adults who opted for HCBS waivers grew 58 percent from 2001 to 2007, while the nursing home caseload decreased 8.5 percent.
March 18, 2013
New York State Department of Health
Denise Soffel, PhD | Principal | Contributor
Robert Buchanan, MPP | Senior Consultant | Contributor
Tom Dehner, JD | Managing Principal | Contributor
David Fosdick | Senior Consultant | Contributor
Lisa S. Maiuro, PhD, MSPH | Senior Consultant | Contributor
The New York State Department of Health enlisted Health Management Associates (HMA) to analyze available options for selecting a Medicaid benchmark benefit for people eligible for Medicaid’s new mandated adult category established by the Affordable Care Act (ACA).
This analysis reviews the revisions to Medicaid eligibility established by the ACA as it affects populations already covered under New York’s Medicaid and Family Health Plus programs, as well as those currently ineligible for public coverage. HMA colleagues identify and describe the options for a Medicaid benchmark benefit as defined by the ACA. The report also reviews the current Medicaid benefit package against the Essential Health Benefit standard and compares it with each of the Medicaid benchmark options.
The report concludes by discussing the implications of selecting a Medicaid benchmark in terms of the impact on currently covered groups and the comprehensiveness of the scope of benefits offered.
February 27, 2013
Sharon Silow-Carroll, MSW, MBA | Managing Principal | Contributor
Jennifer N. Edwards, DrPH, MHS | Managing Principal | Contributor
Diana Rodin, MPH | Consultant | Contributor
HMA recently published a report detailing the 10 leading states’ strategies for using managed care to promote quality, cost-effectiveness, and better health outcomes for vulnerable Medicaid populations.
Authors examined Medicaid “levers” used with both licensed managed care organizations (MCOs) and new integrated delivery systems such as accountable care organizations (ACOs). After a thorough review, report authors concluded that state Medicaid programs have a significant opportunity to play an essential leadership role in promoting greater accountability for quality and cost of care through contracting requirements, incentives, technology supports, and engaging MCOs, ACOs, and other stakeholders. States can engage these groups to develop and implement new payment and delivery strategies, share best practices and align quality improvement initiatives. In fact, doing so holds great promise for improving quality, access, and cost-effectiveness of care for vulnerable populations.
The authors also concluded there’s plenty of room for MCOs and ACOs to not only co-exist in serving Medicaid populations, but interface as they’re moving in similar directions toward greater accountability among health care providers for quality and cost.
This work was supported by a grant from The Commonwealth Fund, a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.