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Medicaid Health Plans Are Improving Access And Quality Of Care

posted by Alicia Caramenico

on July 8, 2015

As states look at how to provide high-quality, affordable care to Medicaid beneficiaries, more are turning to Medicaid managed care for the care coordination and support Medicaid health plans provide for millions. Nearly two-thirds of all Medicaid beneficiaries rely on Medicaid health plans for their coverage.

With innovative and effective programs, Medicaid health plans are meeting the health needs of individuals and families across the country. This includes using telehealth technology to make sure members living in rural areas can access care when they need it. For example, Medicaid health plans have partnered with Project ECHO™ (Extension for Community Healthcare Outcomes) at the University of New Mexico, a program that trains primary care providers to treat chronic and complex diseases in rural and underserved areas via video-teleconferencing.  Plans support the telehealth and primary care sites to build capacity and necessary infrastructure through investments.

A report in the New England Journal of Medicine demonstrated the ECHO™ model overcame health care access barriers by bringing expertise and clinical resources to rural clinicians, which positively impacted patient outcomes. The ECHO model not only provided the right care for patients, it also was associated with high rates of cure for hep C.

Medicaid health plans also engage with community-based organizations and advocacy groups to facilitate members’ access to both medical and non-medical services. These relationships help beneficiaries maintain independent lifestyles and self-direction in accessing housing, personal care/assistant services. One Medicaid health plan partners with a community-based organization to provide coupons that double an individual’s purchasing power, allowing him or her to purchase more healthy food options, such as fresh fruit and vegetables.

Care coordination plays a major role in how Medicaid health plans address the array of medical and non-medical needs that affect the whole person. A great example of this is Amerigroup’s Medicaid efforts in Kansas, where KanCare Health Homes address all of a person’s physical and behavioral health care needs with long-term care services and supports for people with chronic conditions.

Amerigroup’s Medicaid health plans also show how important care management is in helping members get and stay healthy. When diabetes and high blood pressure caused an Amigroup KanCare patient to lose her sight and have near-fatal heart attacks, a case manager made sure she started seeing a primary care doctor for routine checkups and organized transportation to and from appointments. Five months later, the patient’s blood pressure and blood sugar levels improved and she was able to receive a procedure to restore some of her sight.