Survey: Medicaid MCOs Focus Value-Based Purchasing Efforts on Primary Care

Sept. 23, 2019
Sixty-six percent of health plans indicated that the percentage of payments to hospitals through alternative payments was less than 15 percent

The Institute for Medicaid Innovation’s second annual survey of Medicaid managed care organizations (MCOs) found that 82 percent of health plans implemented value-based purchasing arrangements with primary care providers, while very few established similar arrangements with behavioral health providers, dentists, home and community-based service providers and long-term care facilities.

IMI’s survey was developed to address the paucity of national data on Medicaid managed care. For the 2019 survey, representing coverage in 2018, the Medicaid MCOs that responded to the survey represented 69 percent of all covered lives in Medicaid managed care across every state with Medicaid managed care.

In addition to the focus on working with primary care, the survey report notes that more than 66 percent of health plans indicated that the percentage of payments to hospitals through alternative mechanisms was less than 15 percent, “which indicates Medicaid MCOs’ clear preference to work directly with primary care providers over hospitals to establish value-based purchasing arrangements," the report said.

High-Risk Care Coordination

The survey also explored levels of high-risk care coordination. In 2018, 56 percent of Medicaid MCO respondents indicated that less than 6 percent of their members received high-risk care coordination services. The most common barriers cited in completing an individual health risk assessment were inaccurate member information (e.g., phone number) (95 percent), difficulty reaching a member (95 percent), and lack of member’s willingness to participate in a needs assessment (95 percent). The most common barriers cited by Medicaid MCOs in providing high-risk care management were members’ willingness to engage (100 percent), ability to contact member (95 percent), availability of social supports (78 percent), and members’ unmet social needs (78 percent). Of the state-mandated core functions of high-risk care coordination (e.g., served as a single point of contact for the member, developed a plan of care), the majority of health plans always provided these core functions to members.

Social Determinants of Health

In 2018, 78 percent of all Medicaid MCO respondents indicated that they offer targeted social determinant of health (SDOH) programs, with 100 percent of large health plans (more than one million covered lives) having such programs. The most common populations that were targeted for SDOH programs were pregnant women (86 percent), homeless/housing insecure (79 percent), and adults with substance use disorders (72 percent).

 The report noted that multiple screening tools being used. Fifty percent indicated they use an internally developed or adapted tool, with 15 percent not using any tool.

The most common barriers cited that states could address to support SDOH efforts included data sharing, increased resources, standardization of the 834 enrollment file to include social needs information, and contracting (i.e., challenges with community-based organizations).