medicaid health plan best practices - thomas johnson
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Medicaid Health Plan Best Practices
Partnership to Fight Chronic Disease
Thomas L. Johnson
President and CEO
May 24, 20111
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About MHPA
Leading association solely representing Medicaid health
plans. MHPA is a nonprofit, taxexempt organization
formed in 1993 and incorporated in 1995.
27 members in 33 states and DC
representing nearly 14 million Medicaid/CHIP enrollees
The mission of MHPA is to develop and advance public
policy that controls costs and improves access and
delivery of quality health care to Medicaid members.
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35 States and DC Have Medicaid Health
Plans
Even before the
expansion
Expanded
enrollment inexisting managed
care states
Possibility for
business in new
states
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2014 Medicaid Expansion
Medicaid Health Plans Will Be Asked To
Cover more enrollees
Provide
new
services
Pharmacy and
other carve-ins
Long-term care
Cover
new
popula
tions
Dual eligibles
ABDs
Newly-eligible(
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Benefits of Medicaid Health Plans
Better access to care and care coordination
Access to a medical home
Higher enrollee satisfaction
Quality improvement
Delivery system innovation
Predictable costs
Cost savings
Reduced fraud and abuse
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Medicaid Beneficiaries Are Sicker
Example Asthma
Prevalence is almost 12% in poor, 7% in nonpoor
Significant disparities in asthma treatment care
40% of uninsured cant buy meds vs 11% of insured
Sources: CDC MMWR May 6, 2011 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a4.htm
MHPA Asthma Compendium, 2011
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http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a4.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a4.htm -
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Quality and Access More Challenging for
Poor, MinoritiesSource: AHRQ National Healthcare Quality Report
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Health Plans are Accountable
Health plans measure and report
Accountable for improvements over time
Source: Medicaid Managed Care Quality Benchmarking Project. Report to CMS August, 2010
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Diabetes Results
Source: Medicaid Managed Care Quality Benchmarking Project. Report to CMS August, 2010
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Best PracticeAccountability for
Prevention
Midwest Health Plan BMI Initiative
Source: MHPA Compendium, 2010 10
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Best Practice Innovation
Centene Corporation CONNECTIONS Plus
Chronic disease focus/ research design
Case Management identification
MemberConnections home visit and education
Free preprogrammed phone
Podcast, personal phone contact
Results: 38% drop in inpatient, 29% drop ALOS, 20%
drop in ER use
Source: MHPA Compendium 2010
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Best PracticeAccountability for Cost and
Quality
Group Health Cooperative of Eau Claire
Asthma disease management patients
identified through risk assessment, data
Outcomes:
46% decrease in ER costs 20082010
51% decrease in ER use (39 visits/1000 lives to19 visits/1000 lives
Source: MHPA Asthma Compendium, 2011
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Challenges to Medicaid Plans
Short duration of eligibility
Carve outs
Low reimbursement (limits providerparticipation)
These factors hinder member engagement andcare coordination
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Questions
Thomas Johnson
President & CEO
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Liza Greenberg
Senior Consultant
Visit MHPAs Website
www.mhpa.org
mailto:[email protected]:[email protected]://www.mhpa.org/mailto:[email protected]:[email protected]://www.mhpa.org/