While social determinants of health (SDOH) have been a topic of much discussion and a driver toward understanding and furthering health equity, definitions and approaches vary across the healthcare spectrum.
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Missouri Releases Medicaid Managed Care RFP
This week our In Focus reviews the Missouri MO HealthNet (MHD) Medicaid Managed Care Program request for proposals (RFP), released on November 19, 2021, by the Department of Social Services (DSS). The MHD managed care program serves about 850,000 Medicaid and Children’s Health Insurance Program (CHIP) members including the state’s newly implemented Medicaid expansion population, across all regions of Missouri. Missouri’s General Plan managed care program covers TANF, CHIP, expansion and similar eligibility groups but does not include individuals with disabilities or those over age 65. The RFP also contains a separate section for a single, statewide Specialty Plan for foster children and children receiving adoption subsidy assistance. Managed care organizations must bid on and win a General Plan contract in order to be eligible for the Specialty Plan contract.
HMA report compares quality outcomes across state Medicaid program delivery models
A recently completed analysis of the impact of Medicaid managed care on key quality indicators found managed care organizations (MCO) outperformed fee-for-service (FFS) and primary care case management (PCCM) programs for both Child and Adult Core Set measures, once the data was normalized with respect to beneficiary distribution in each model.
The resulting report was in response to more states transitioning Medicaid beneficiaries from FFS to MCOs with a goal of reducing costs and improving quality. The HMA team, David Wedemeyer, Anthony Davis, Sharon Silow-Carroll, and Joe Moser, used the 2019 Centers for Medicare & Medicaid Services (CMS) Core Set of Adult and Child metrics that cross the care continuum to develop a standardization model. The model aimed to classify quality outcomes on a state-by-state basis, based on the percent of members in direct FFS arrangements, MCOs, and PCCM programs.
The analysis suggested that performance differences could be attributed to the fact MCOs have structured care coordination and specialized programs, such as disease management, population health programs, and social determinants of health programs in place. As the HMA team drilled down into sub-sections of the Core Set related to key domains such as preventive care, women’s health, disease management, and behavioral health, the findings were consistent in that MCOs tended to perform higher overall when compared to FFS and PCCM across all major domain categories.
In summary, HMA’s findings suggest that the growth of Medicaid managed care plans has led to higher quality scores in several core areas of adult and child measures, lending support to the idea that managed care has had a positive impact overall on the quality of care for Medicaid members across the country. Additionally, HMA’s review of the data and the team’s deep understanding of state oversight of managed care programs suggests that when a state strongly embraces a quality improvement framework as a long-term strategy and partners with its managed care plans on performance-based contracts, quality scores and outcomes may be stronger. The report also suggests that stronger state efforts to work with managed care plans to develop clear expectations and collaboration, while also leveraging MCOs’ access to clinical and quality data sources, may contribute to higher quality scores.
HMA report evaluates quality outcomes across various state Medicaid program delivery models
A recently completed analysis of the impact of Medicaid managed care on key quality indicators found managed care organizations (MCO) outperformed fee-for-service (FFS) and primary care case management (PCCM) programs for both Child and Adult Core Set measures, once the data was normalized with respect to beneficiary distribution in each model.
Former CMMI director joins HMA, will help lead Medicare team
Amy Bassano, former deputy director for the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid Services, has joined national healthcare consulting firm Health Management Associates (HMA), taking the helm as a managing director of Medicare services.
Rhode Island Releases Medicaid Managed Care RFQ
This week our In Focus reviews the Rhode Island Medicaid managed care request for qualifications (RFQ), released on November 12, 2021, by the Executive Office of Health and Human Services (EOHHS). Contracts are worth approximately $1.4 billion annually and cover over 300,000 individuals.
Former South Dakota Medicaid Director Joins Leavitt Partners, an HMA Company
Bill Snyder, former South Dakota Medicaid director, has joined Leavitt Partners, an HMA Company as a principal with the firm. He is the third former Medicaid Director to join the Health Management Associates (HMA) family of companies this year.