Going Beyond Medical Care: Delivering Value with Medicaid Managed Care

By Kelly Munson

Today, 40 states partner with managed care organizations (MCOs), or private health insurance providers, to administer their Medicaid benefits and cover the costs of delivering care (North Carolina, the 40th state, is expected to launch its managed care program on Nov. 1, 2019). These plans now cover more than 66 million of the 73 million Americans who depend on Medicaid, the largest source of public health insurance coverage in the nation.

States have increasingly turned to MCOs as their Medicaid populations and spending have grown. In 2016, Medicaid accounted for 17.1% of state budgets, up from 14.3% in 2007. While Medicaid costs have continued upward, MCOs have helped curb that trajectory. The Menges Group estimates MCOs delivered nationwide Medicaid savings of $7.1 billion in 2016 and are projected to save $94 billion over the next decade.

Much of those savings can be attributed to innovative care management approaches developed to address both the health and social needs of Medicaid beneficiaries. After all, providing access to just medical care is not enough when it comes to serving low-income, vulnerable populations. Homelessness, food insecurity and inadequate transportation are just some of the social determinants of health many Medicaid members face when it comes to accessing medical care and adhering to treatment plans. To overcome these barriers, support for members must go beyond the walls of the doctor’s office and address the realities they face in their homes and communities.

An approach that is showing real success is a field-based care model where care managers engage with patients face-to-face, meeting them where they live to gain a fuller understanding of the member’s health and life circumstances. They also collaborate with community organizations and healthcare providers to coordinate care and provide needed social services such as food, housing or transportation to and from medical appointments. At WellCare, our Medicaid members who received field-based care management experienced a 26% decrease in hospital admissions and 20% fewer visits to the ER.

We have also seen positive cost and quality outcomes associated with WellCare’s Community Connections Help Line, a toll-free line that connects both members and non-members to local, community-based resources that address such issues as homelessness, utilities assistance, education or child care. A University of South Florida study found those members who accessed services through WellCare’s Help Line saw a 10% reduction in healthcare costs, and compared to demographically similar members, those with social barriers removed through the Help Line were nearly five times more likely to schedule and attend a visit with their primary care doctor; 2.4 times more likely to improve body mass index (BMI); and 1.5 times more likely to comply with diabetes treatment.

As state governments continue to look for innovative ways to care for their Medicaid populations, managed care helps reduce spending and delivers value by helping those with basic unmet needs live better, healthier lives.

Munson_KellyKelly Munson is Executive Vice President of Medicaid for WellCare Health Plans     

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