Survey Highlights Medicaid MCO Challenges in Data Collection, Sharing

Nov. 8, 2022
Institute for Medicaid Innovation survey also finds that 47 percent of Medicaid managed care organizations are making payment arrangements with downside risk

The findings of the Institute for Medicaid Innovation's (IMI) 2022 Medicaid managed care organization (MCO) survey highlight issues with data collection and communication that affect enrollee care. IMI said that while data collection and sharing have been longstanding challenges, in the U.S., the issues became more pronounced during the pandemic when data circulation became a key part of the infection control strategy.

The IMI is a nonprofit, nonpartisan research and policy organization that provides independent information and analysis to inform Medicaid policy.

Among the 2022 survey's findings:

• 71 percent of health plan respondents cited access to information from previous providers as a key barrier to care coordination.

• 67 percent of health plans said their information technology systems were a barrier to setting up effective telehealth delivery services. Data collection issues hamper Medicaid's ability to effectively measure, monitor, and assess population health and improve equity.

“The need for accurate and accessible data is clear as we consider its impact on the quality of care for Medicaid enrollees,” said Jennifer E. Moore, Ph.D., R.N., founding executive director of IMI, in a statement. “The survey results show widespread challenges with data interoperability across many of the survey categories. This is an area replete with opportunity as we look towards future innovations in Medicaid."

IMI said the results also underscore the role of uncertainty around data sharing policies and differences in state-level regulation in hampering health plans' efforts to coordinate care and connect enrollees to services and supports. Policy and regulatory changes made during the public health emergency would improve care for enrollees if made permanent, the organization added. Known barriers to care were reduced when flexibilities were introduced during the public health emergency, such as continuous enrollment and telehealth access.

• 90 percent of health plans reported enacting service and benefit flexibilities and strengthening their telehealth capabilities.

• 71 percent of health plans believe that these flexibilities increased patient access.

The survey also highlighted the increasing role of value-based payment arrangements in Medicaid managed care:

• 68 percent or respondents said they are making global or capitated payments to primary care providers or integrated provider entities.

• 53 percent are making bundled or episode-based payments.

• 47 percent said they are making arrangements with downside risk.

• 32 percent say payment withholds are tied to performance.

• 21 percent say they are making upfront payments to encourage faster movement to more advanced APMs.

Medicaid health plan respondents identified some changes to state requirements and guidance that would assist them to effectively implement value-based payment and/or alternative payment models:

• 79 percent said better education for providers on state and health plan expectations.

• 68 percent said reporting of consistent metrics.

• 47 percent said more flexibility in the design of VBP components (e.g., member attribution, benchmarking).

• 47 percent said removal of data sharing restrictions.

• 42 percent said provision of additional policy and/or fiscal levers for MCOs to ensure provider engagement in VBP models.

• 42 percent said streamlined VBP design across payers, including aligned performance measures.

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