In the more than 20 years that I have been working in health care, the only thing that has been consistent is change. Political shifts have resulted in new policies. Fiscal crises have impacted budgets at both the federal and state levels. Population changes have caused an increase in the number of individuals accessing Medicaid. And the needs of members have become more complex.
To capture these changes, UnitedHealthcare Community & State creates an emerging trends report each year that highlights the developments and reforms taking place in the Medicaid system. For the first time, we are releasing this report publicly. In this 2019 Emerging Trends in Public Programs White Paper, we identify 10 trends that relate to an important change in the way the public health care system operates and how those who interact with the system — providers, consumers and managed care organizations — do so.
Trend 1: Continuum of Coverage and System Integration
Trend 2: Medicaid Expansion and Consumer Engagement
Trend 3: Delivery System Reform
Trend 4: Value-Based Purchasing
Trend 5: Care for Complex Populations
Trend 6: Evolving Opioid Crisis
Trend 7: Pharmaceuticals
Trend 8: Social Determinants of Health
Trend 9: System Convergence
Trend 10: Mergers, Partnerships, and New Entrants
There are clear factors contributing to the trends we’re seeing; the Medicaid population is becoming more complex and the system itself is facing new and more complicated challenges. These include the expanding manifestations of the opioid crisis; a growing maternal mortality; and increasing coverage of an expansion population that has greater health care difficulties along with a greater chance of enrollment turnover. Budget pressures are also increasing; Medicaid is the largest total state expenditure, up almost 10 percent in the last decade.
States are responding to these current system challenges and the longer-term trends of an aging population and the need to serve more complex populations by:
- Shifting and expanding coverage responsibility of managed care organizations;
- Delegating greater responsibility and risk to managed care organizations and individual providers; and
- Broadening responsibility for care to traditional and new Medicaid populations.
Even though each state Medicaid system is unique, there is increasing convergence around utilizing managed care organizations to address both rising costs and increasing consumer needs. In fact, today upwards of 55 million Americans, 75 percent of total Medicaid enrollment, now receive Medicaid coverage from a private managed care plan.
While changes will continue to take place in the Medicaid system, our focus at UnitedHealthcare is on working with our state and federal partners to respond to these challenges and trends in order to strengthen and enhance Medicaid’s long-term viability as the safety net public medical assistance program it was originally envisioned to be.