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Medicaid Health Plans: Coordination, Innovation, Personalization

posted by Alicia Caramenico

on June 12, 2015

At the 2015 AHIP Institute in Nashville last week, attendees got a firsthand look at some of the innovative care management strategies Medicaid health plans use to ensure high-quality, coordinated care. Two Medicaid health plan executives shared how their plans are providing access to better care, better health outcomes, and better value for their low-income beneficiaries.

Erhardt H. L. Preitauer, president of Horizon New Jersey Health said his health plan is focusing on the unique needs of the individual. He added that using data to predict and understand the risks of each patient has made a big difference in quality of care and patient outcomes. For example, specific data points, like social and geographic issues, help determine where to focus efforts for its high-risk pregnancy program.

Preitauer also discussed how the Medicaid health plan is managing beneficiaries holistically. Horizon has found success with nurse practitioners and field-based care coordinators who bring services to patients in their communities.

Similarly, Health Care Service Corporation (HCSC) is meeting its Medicaid beneficiaries where they are by forming strong community-based partnerships. HCSC leverages the existing relationships community organizations already have with members to better coordinate their care, said Julie Faulhaber, vice president of Enterprise Medicaid at HCSC. She also highlighted in-home care planning, embedded care coordinators, and social services support as other key elements of successful care management.

These are just two examples of Medicaid health plans delivering comprehensive care that improves quality for more than 43.5 million low-income individuals. Visit our Medicaid Managed Care issue page for more information on how these plans are meeting the demands of growing Medicaid populations.