As a national, nonprofit, nonpartisan research and policy organization, the Institute for Medicaid Innovation (IMI) aims to address challenges within the Medicaid space through data analysis and multi-stakeholder engagement.¹ To this end, IMI’s annual Medicaid Managed Care Organization (MCO) survey is at the forefront of longitudinal Medicaid data collection efforts. The MCO survey provides a comprehensive view of the latest trends and best practices across 12 categories of care.
2023 Findings
- High-risk care coordination
- The top three barriers experienced by Medicaid health plans when providing high-risk care coordination include:
- Ability to contact members
- Member willingness to engage with high-risk care coordination
- Unmet needs related to social drivers of health (SDOH)
- The top three barriers experienced by Medicaid health plans when providing high-risk care coordination include:
- Alternative payment models
- The top three changes to state requirements or guidance that would assist Medicaid health plans to effectively implement value-based payment or alternative payment models (VBP/APM) includes:
- Provision of additional policy to ensure provider engagement in VBP models
- Better education for providers on state and health plan expectations
- Reporting of consistent metrics
- The top three changes to state requirements or guidance that would assist Medicaid health plans to effectively implement value-based payment or alternative payment models (VBP/APM) includes:
- Pharmacy
- The top pharmacy benefit initiative implemented to address the opioid epidemic was pharmacy/prescriber lock programs for members using multiple prescribers
- Behavioral health
- The top two methods that health plans use to address access barriers for child and adolescent behavioral health service integration are:
- Contracting with more virtual behavioral health providers
- Educating members to help destigmatize mental illness
- The top two methods that health plans use to address access barriers for child and adolescent behavioral health service integration are:
- Maternal and perinatal health
- From 2021 to 2023, community health worker services, doula services and lactation counseling services saw the largest increases in covered benefits for pregnant individuals
- Sexual and reproductive health
- “Low or no availability of providers in certain geographical areas” is the top barrier to accessing sexual and reproductive health services
- Child and adolescent health
- 73% of Medicaid health plans cover child and adolescent comprehensive obesity treatment
- Managed long-term services and supports (LTSS)
- Nursing facility-to-home transitions were indicated by health plans to be primarily impacted by inadequate caregiver support and housing/bed availability
- Social drivers of health (SDOH)
- 79% of responding health plans indicated they made policy changes to support SDOH initiatives
- COVID-19
- The primary strategy deployed in response to the pandemic was the extension, removal and alteration of authorizations
- Health equity
- Only 29% of Medicaid health plans have pursued NCQA Health Equity Accreditation but 58% are planning to pursue
- Telehealth
- 58% of responding health plans indicated that state Medicaid support for school-based health services delivered via telehealth could help health plans create more equitable access to telehealth overall
The information captured through IMI’s annual Medicaid MCO survey provides helpful insight into the trends in Medicaid health plan service delivery. It also provides a benchmark of our work against our peers helping to challenge us to consider new and different services and supports for those we serve.
Full 2023 MCO survey results can be found on the IMI website.
