Washington, D.C.

Nashville, TN

search

The Value Of Medicaid: 3 Questions & Answers About Managed Care

by AHIP

September 24, 2018

Medicaid health plans help millions of Americans access quality health care services, increasing the importance and popularity of coordinated care among states and enrollees. AHIP’s Medicaid policy leads, Mark Hamelburg and Rhys Jones, weigh in to share more insight on the value that the program continues to bring year after year.

1. Why are more states turning to managed care for their Medicaid populations?

States rely on Medicaid health plans to promote high-quality, coordinated care for their growing Medicaid populations for three primary reasons:

  • Quality: Medicaid health plans improve access to care for Americans by emphasizing the role of primary care providers who identify, treat conditions, and connect Americans with specialists for more complex needs. Improved access to primary care also decreases hospitalizations that occur when conditions are left untreated. And Medicaid health plans have been shown to outperform national benchmarks on quality measures.
  • Cost Effectiveness: Medicaid health plans help states achieve budget predictability, control costs, and realize the highest value for their Medicaid investment. For example, states can save up to 20 percent when Americans are enrolled in Medicaid health plans. And states using Medicaid health plans to manage prescription drug benefits saw a combined savings of over $2 billion in one year.
  • Accountability: Medicaid health plans must undergo rigorous review processes. States hold plans accountable through the public reporting of performance outcome measures, requirements for quality improvement programs, and provider network adequacy standards.

2. What results do people in Medicaid managed care plans see in terms of clinical outcomes and quality of care?

States have seen a wide range of benefits for people with Medicaid. New Mexico saw hospital admissions reduced 19 percent, nursing facility use reduced by 17 percent, and emergency department visits reduced by eight percent after implementing a managed long-term services and supports program for adults with disabilities and older adults.

In South Carolina, adults with diabetes covered by Medicaid health plans were more likely to receive consistent monitoring and support for their conditionSixty-three percent of adults covered by a Medicaid health plan monitored their blood sugar, compared to 33 percent of adults covered by Medicaid fee-for-service (FFS).

Additionally, in Georgia, children enrolled in Medicaid health plans are more than twice as likely to experience six or more well-child visits during the first 15 months of life.

3. What role does managed care play in the shift to value-based, patient-centered care?

As states and policymakers look to sustain the Medicaid program, health plans’ programs and tools can help lead transformations that impact the larger health care delivery system. According to a recent survey of Medicaid health plans, 93 percent of plans now pay some of their providers based on quality and performance.  The focus of Medicaid health plans on detecting and preventing the progression of chronic diseases, coordinating services across the continuum of care, and delivering programs targeted to individual needs are significantly improving quality and outcomes for low-income Americans.