AHIP hosted a briefing on Capitol Hill yesterday on how Medicaid health plans improve access and quality of care for beneficiaries while providing cost savings to states.
Presentations:
The briefing featured presentations from four Medicaid health plan executives (click links to view their presentations):
- Michael Dudley, President of Sentara Health Plans
- Gary Call, M.D., Vice President of Medicare and LTC Programs for Molina Healthcare
- Michael Rashid, President and CEO of the AmeriHealth Mercy Family of Companies
- Robert Wychulis, CEO of Amerigroup New York
Highlights of Media Coverage:
CQ HealthBeat: Medicaid Health Plan Executives Make the Case for More Managed Care (subscription required)
- Michael Rashid, the president and CEO of AmeriHealth, said his plans have saved the Pennsylvania health program almost $3 billion over five years and the South Carolina program $70 million since 2002.
- Gary Call, corporate vice president of Molina, said that by using case management, health plan officials had increased screenings of prostate cancer from about 17 percent of patients in 2006 to 63 percent in 2010 and cholesterol screenings from about 16 percent of people in 2006 to nearly 62 percent in 2010.
- The executives said that they were able to achieve better outcomes than fee-for-service Medicaid in part because they had case managers call or visit patients to make sure that they were following physicians’ instructions and keeping appointments rather than going to emergency departments.
InsideHealthPolicy: Health Plan Execs Tout Medicaid Managed Care As Solution To State Woes (subscription required)
- The briefing on Capitol Hill, organized by America’s Health Insurance Plans, was meant to “shine a spotlight” on the benefits Medicaid managed care plans can provide states and give “real solutions,” AHIP President and CEO Karen Ignagni said.”
- States are looking to Medicaid managed care plans to build necessary infrastructure and coordinate care among beneficiaries not just because of the law’s Medicaid expansion but also because of the aging population that is pressing on the states, said Robert Wychulis, CEO of Amerigroup New York.
- “Access is a big issue for policy makers now, especially when you talk about bringing close to 16 million new people onto Medicaid,” said Michael Rashid, the CEO of Philadelphia-based AmeriHealth Mercy Family of Companies. “Success is a lot more than just having a contract with a doctor.”
- All the Medicaid managed care analysis that went into deciding how to transform New York’s Medicaid program showed cost savings, Wychulis said, which was why the state decided to phase the rest of the Medicaid population into managed care over the next three years. There were clear savings shown not just from hospital admissions and readmissions but preventable ambulatory issues such as asthma and diabetes, he said.
- Beyond savings, Gary Call with Molina Healthcare said Medicaid managed care plans do outreach and coordination that does not take place in traditional fee-for-service plans.
“We are able to impact these problems that are plaguing the health care system,” he said.
Politico Pro: Some states fast-track expansion (subscription required)
- The state-level efforts come in tandem with Medicaid managed care health plans, who tell POLITICO they’re now “scaling up” in hopes of absorbing many of the 16 million new enrollees expected to join the program post-2014.
“We’re preparing for the inevitable explosion,” says Gary Call, vice president of Molina Health Plans, which operates Medicaid managed care programs in 16 states.
- Many [states] have looked to Medicaid managed care providers as a cost-saver over the insurance program’s traditional, fee-for-service model. Seventy-two percent of all Medicaid beneficiaries received some or all care from a managed care provider, according to a May report by the Association of America’s Health Insurance Plans.
- The experience of states that have signed up for the early Medicaid expansion give managed care companies even more reason for optimism, seeing quick uptake of the new benefits that translate into a potential wave of customers.
Background materials:
Medicaid Health Plan Enrollment and Participation Trends (May 2011)
Of the 50.5 million Medicaid beneficiaries nationwide, 23.9 million were enrolled in a Medicaid health plan as of June 30, 2009, an increase of 2.4 million since 2008. According to the Centers for Medicare & Medicaid Services (CMS), beneficiaries were enrolled in Medicaid health plans in thirty-three States, plus the District of Columbia, and Puerto Rico in 2009. Seventy-two percent of all Medicaid beneficiaries received some or all care through some form of managed care instead of fee-for service in 2009.
Medicaid Health Plans: Adding Value for Beneficiaries and States
Medicaid health plans have been at the forefront of implementing systems and programs that not only provide positive results for beneficiaries but also aid States in controlling Medicaid costs and achieving the highest value for their Medicaid investment, including:
- By offering integrated health care delivery systems, Medicaid health plans promote access to coordinated, quality care and prevent overutilization of services that are both unnecessarily costly and potentially harmful to their members.
- By conducting outreach and health education efforts that encourage Medicaid beneficiaries to receive necessary preventive care, Medicaid health plans can reduce unnecessary and costly hospital stays.
- By helping to manage chronic conditions through patient-centric disease management programs, Medicaid health plans are improving care while also reducing the costs of providing health care to beneficiaries with high health care needs.
- By facilitating access to non-medical services, Medicaid health plans enhance the effectiveness health care service delivery for their members and at the same time reduce costs for states, for example by facilitating access to social services or to services that help reduce or avoid nursing home stays for beneficiaries with long-term health care.
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