Study: Innovation Around Telehealth, Population Health, Happening Now in Medicaid Managed Care

May 6, 2020
A new study commissioned from The Menges Group by AHIP (American’s Health Insurance Plans) finds innovation taking place in Medicaid managed care plans in a variety of areas, including telehealth and population health

A new study published on May 6 examines some of the innovative programs that are improving care delivery and benefits for enrollees, among Medicaid managed care plans nationwide. The study is based on research conducted by The Menges Group, conducted on behalf of America’s Health Insurance Plans (AHIP).  That research, leaders at AHIP note, is particularly important during the COVID-19 crisis, as one in five Americans rely on Medicaid for their healthcare coverage today, with two-thirds of enrollees served by a Medicaid managed care health plan. Medicaid enrollment could increase by 11 to 23 million as a result of COVID-19. Health insurance providers are working with federal, state and local leaders to overcome the crisis, and they remain committed to delivering access to high-quality care and innovations to improve health and outcomes that Medicaid managed care enrollees deserve.

The study, entitled “The Value Of Medicaid Managed Care: Innovating In Medicaid,” focuses heavily on innovations in telehealth and in the areas around the social determinants of health (SDOH).

The major takeaways from today’s study include:

Ø  Medicaid managed care plans are creating and covering telehealth programs that expand access to care and increase the ability of doctors to coordinate care for patients. These solutions address rural access to care, behavioral health services, and chronic pain management.

Ø  Medicaid managed care plans are demonstrating breakthrough programs to reduce social and financial barriers to health, such as deploying mobile produce markets with fresh vegetables to neighborhoods with limited supermarket access, or teaching enrollees with chronic health conditions how to cook healthy meals.

Ø  Medicaid managed care plans are improving the ways enrollees can access provider networks, including creating tools that allow enrollees to more easily locate doctors in their networks, view practice information, and rate their doctors.

Today’s announcement marks the third of a series of studies on the performance of Medicaid managed care plans conducted by The Menges Group for AHIP. Additional studies will cover the value plans bring to states, as well as their financial performance.

As the report notes, “Many state Medicaid agencies use formal procurement processes to select and contract with qualified Medicaid managed care plans. In most states, the Medicaid agency releases a Request for Proposal (RFP) that requires Medicaid managed care plans to implement innovative care delivery solutions. The Menges analysis reviewed state Medicaid RFPs and accompanying model contracts and scopes of work from recent procurements in eight states,” the report notes. The Menges Group also reviewed 14 Medicaid plan proposals submitted in 6 states.”

As the report states, “In recent years, state Medicaid procurements have added significant requirements, calling for Medicaid managed care plans to address a range of innovations and improvements in care delivery and benefits. The procurement process also encourages Medicaid managed care plans to make commitments that exceed state contract requirements to earn contract awards. These efforts have allowed Medicaid programs with Medicaid managed care plans to offer high-value initiatives that improve care and outcomes for their residents while controlling costs for taxpayers. The findings show that Medicaid managed care plans collaborate with their state partners to deliver successful public private partnerships uniquely tailored to meet the needs of each individual state and the populations that are served by that state’s Medicaid program, proving that when the public and private sector work together, Americans get the quality and value they deserve.”

Of course, telehealth is necessarily central to much of this. As the report states, “Telehealth is an area where Medicaid managed care plans are providing states with innovations beyond what is possible in fee-for-service Medicaid programs. Five of the states reviewed require Medicaid managed care plans to cover telehealth services between patients and primary care physicians – and often between patients and specialists. While most contracts did not specify how Medicaid managed care plans should focus their telehealth efforts, 1 state directed Medicaid managed care plans to focus telehealth strategies on rural areas, behavioral health services, and chronic pain management. Medicaid managed care plans proposed innovative telehealth solutions to improve access for enrollees and providers alike. Most focused on areas such as telepsychiatry, remote monitoring, virtual urgent care, and mobile applications in support of chronic condition management. One Medicaid managed care plan proposed to implement Project ECHO, a tele-mentoring program that connects primary care providers and patients in rural areas to specialist physicians through a model that ‘moves information without moving people.’”

The report also notes that “Five states require Medicaid managed care plans to implement population health programs.” It states that “Population health requirements are a relatively new feature in Medicaid procurements, making their debut in 2018 and 2019 contracts. Some population health requirements included creating prevention and wellness programs targeted to different population segments, as well as programs designed to address the leading health issues affecting enrollees.”

Further, it references the fact that “Some states also had additional requirements covering specific enrollees. For example, states required Medicaid managed care plans to:

Ø   Create individualized, interdisciplinary care teams and care plans for children in foster care that integrate care managers, primary care physicians, and dental providers. (Kentucky’s Supporting Kentucky Youth model)

Ø  Conduct initial home visits with foster children within 48 hours of a new home placement and schedule an interdisciplinary care meeting within 7 days of the placement. (Kansas)

Ø  Provide care management to at least 15 percent of the Medicaid MCO’s total membership, targeting high-risk enrollees such as adults with HIV/AIDS, and to at least 50% of all high-risk enrollees (New Hampshire).

A link to the text of the full report can be found here.