Highlights and Takeaways from the Institute for Medicaid Innovation's Annual MCO Survey

For the second year in a row, the Institute for Medicaid Innovation (IMI) conducted a survey of Medicaid Managed Care Organizations (MCOs). This one-of-a-kind survey is a comprehensive collection of information about the activities of MCOs developed to help address the lack of robust national data on Medicaid managed care. As a Medicaid MCO, UnitedHealthcare Community & State has participated in the survey for both years.   

The Medicaid MCOs that responded to the survey represent 69 percent of all individuals in Medicaid managed care; and represent every state with managed care. Both quantitative and qualitative data for the 2018 coverage year was collected. The results of the survey help to articulate the role of managed care in Medicaid, providing states with a partner to serve diverse populations with quality care that improves health outcomes and helps states to stabilize their budgets. The report also defined some of the challenges MCOs face as they ensure access for and administer care to their members.

There are nine sections to the survey. The first section provides an overview of the characteristics of Medicaid MCOs based on information provided by the respondents. The rest of the survey is broken down by topic or issue area particularly relevant to the Medicaid system. The topics include: high-risk care coordination, value-based purchasing, pharmacy, behavioral health, women’s health, child and adolescent health, managed long-term services and supports, and social determinants of health. The last section is new to the 2019 survey and was added in large part due to the increasing focus on social determinants of health by both state Medicaid agencies and MCOs.

I have the pleasure of chairing IMI’s Data & Research Committee which includes the subcommittee on the annual Medicaid MCO survey. Even with this front row seat to the development and dissemination of the survey, there were many interesting, and sometimes surprising, takeaways, including the following:

  1. It is very positive and promising that 83 percent of MCOs now provide self-advocacy support as part of their approach to managed long-term services and supports for the aging and disabled populations.
  2.  Ninety-five percent of MCOs identified that inaccurate member information is the number one barrier to completing an individual health risk assessment to determine receipt of high-risk care coordination services. Though not a surprising data point, it reinforces the need for different ways of collecting member information, including increasing efforts to connect with them to gather critical information in order to effectively address their health care needs.
  3.  The use of value-based purchasing continues to increase, with 82 percent of responding plans saying they have value-based purchasing arrangements with primary care providers in 2018. This has increased considerably from 53 percent of responding plans utilizing value-based purchasing in 2017. However, the survey also indicated that very few MCOs engage in these types of arrangements with providers other than primary care providers. As a result, there is a continued opportunity for shifting from volume to value for providers such as dentists, behavioral health providers, and home and community-based services providers. 
  4. Only half of MCOs indicated that they are granted access to review medical records inclusive of both physical and behavioral health. Because research clearly articulates the value in coordinating behavioral health care with physical health care, the continued inability to gain access to records that include both is a limiting factor for MCOs, providers, and ultimately Medicaid consumers.
  5. I thought it was incredibly interesting that MCOs assessed that readiness to start school (40 percent) and success in school (20 percent) were health priorities for children and adolescents. Unfortunately, no MCOs identified having targeted programs or engagement strategies to address these particular priorities.
  6. Though there was much to be learned from the results of the social determinants of health section, one result that stood out to me was the variation in screening tools being used by MCOs. Specifically, half of MCO respondents use an internally-developed screening tool or have adapted versions of other tools. As states and MCOs increasingly focus on addressing social needs in their Medicaid programs, the value of flexibility versus standardization is an area in need of further discussion.

Next year will mark the third year of IMI’s MCO survey. At that time these trends can be assessed, providing further data about the role of managed care in Medicaid, as well as the challenges faced by MCOs as they strive to provide effective and efficient care to their members. This data will only help to strengthen the important partnerships that exists between states, health plans, and providers as we work to improve the health and well-being of the millions of individuals served by the Medicaid system.

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