Insights

HMA Releases Medicaid Managed Care White Paper

Medicaid Managed Care is the subject of a recently released HMA white paper.

In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.

The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:

Planning and implementation
Stakeholder engagement
Procurement approaches
Outreach and enrollment
Contract management and monitoring

The Value of Medicaid Managed Care

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The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:

Planning and implementation
Stakeholder engagement
Procurement approaches
Outreach and enrollment
Contract management and monitoring

HMA’s Smith Part of NAMD Panel Reviewing Medicaid at 50

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HMA Managing Principal Vern Smith was one of four experts who took part in the plenary panel discussion “Medicaid at 50: Past, Present and Future” at the National Association of Medicaid Directors (NAMD) fall conference Tuesday. He was joined by:

Thomas Betlach, NAMD President, Arizona Medicaid Director, AHCCCS
Deborah Bachrach, Partner, Manatt, Phelps & Phillips LLP
Charles Milligan, Jr., CEO, UnitedHealthcare Community & State – New Mexico

The tenures of these Medicaid agency leaders have spanned the history of Medicaid. They discussed how Medicaid has fundamentally transformed from its origins in 1965, and what the future of the program holds. Judith Moore, co-author of Medicaid Politics and Policy, and a health policy consultant, moderated the panel which followed the keynote address of Secretary Sylvia Mathews Burwell of the U.S. Department of Health and Human Services.

Click here to see the discussion as it appears in the video archive of C-Span3.

Report Examines Provider Network Monitoring Practices

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HMA released findings from a qualitative study this week in the report, “Making Affordable Care Act Coverage a Reality: A National Examination of Provider Network Monitoring Practices by States and Health Plans.”

The study examined the standards and practices that state agencies and health plans use to ensure access to care in the period following implementation of the Affordable Care Act (ACA). The report was prepared by HMA’s Karen Brodsky, Diana Rodin, and Barbara Smith with support from the State Health Reform Assistance Network, a Robert Wood Johnson Foundation program.

Based on evidence gathered through surveys of and interviews with key informants in state agencies and plans, the study explores the standards applied by commercial insurance regulators and Medicaid agencies and the practices actually employed by Medicaid managed care organizations (MMCOs) and Qualified Health Plans (QHPs) in Marketplaces to form provider networks and monitor performance.

While the response sample is small, the information provided paints a picture of the range of standards and practices used and the challenges faced, which provides a basis for identifying gaps in current understanding and strategies and opportunities for developing best practices. Among the report’s key findings:

Network standards differ significantly between state insurance regulators and Medicaid agencies
Health plans report they are exceeding states’ network standards
Few states track provider network overlap across plans.

Making Affordable Care Act Coverage a Reality: A National Examination of Provider Network Monitoring Practices by States and Health Plans

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This qualitative study examines the standards and practices that state agencies and health plans use to ensure access to care in the period following the implementation of the Affordable Care Act (ACA). Based on evidence gathered through surveys of and interviews with key informants in state agencies and plans, the study explores the standards applied by commercial insurance regulators and Medicaid agencies and the practices actually employed by Medicaid managed care organizations (MMCOs) and Qualified Health Plans (QHPs) in Marketplaces to form provider networks and monitor performance. While the response sample is small, the information provided paints a picture of the range of standards and practices used and the challenges faced, which provides a basis for identifying gaps in current understanding and strategies and opportunities for developing best practices.

HMA’s Breslin Authors Primer on Medicaid Managed Care Capitation Rates

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HMA Senior Consultant Ellen Breslin prepared the recently released “Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs” for the Massachusetts Medicaid Policy Institute. It includes:

An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs)
The overall process for setting Medicaid managed care capitation rates; and
The various tools states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.

A Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs

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HMA Senior Consultant Ellen Breslin prepared this recently released primer for the Massachusetts Medicaid Policy Institute. It includes:

An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs)
The overall process for setting Medicaid managed care capitation rates; and
The various tools states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.

Annual Survey Finds ACA Drove Record Annual Increases in Enrollment, Total Medicaid Spending

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The Affordable Care Act’s Medicaid expansion resulted in record increases in Medicaid enrollment and spending nationally in fiscal year 2015, with both rising an average of nearly 14 percent. This is just one finding in the 15th annual 50-state Medicaid budget survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

Released Oct. 15, this report provides an in-depth examination of the changes taking place in state Medicaid programs across the country. Health Management Associates conducted the survey of Medicaid directors across the country. The survey shows big differences across states driven largely by the states’ decisions on the Medicaid expansion and also provides an examination of state Medicaid policy and program changes across the country.

HMA Managing Principals Vernon K. Smith, Kathleen Gifford and Eileen Ellis authored the report along with Robin Rudowitz, Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.

Two additional issue briefs were developed as well:

Medicaid Enrollment & Spending Growth: FY 2015 & 2016, which provides an analysis of national trends in Medicaid enrollment and spending.

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016, a collection of three case studies of Medicaid programs in Alaska, California and Tennessee.

Medicaid Enrollment & Spending Growth: FY 2015 & 2016

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This issue brief was released Oct. 15 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15^th annual budget survey of Medicaid officials, “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.”

HMA Managing Principal Vernon K. Smith and Robin Rudowitz and Laura Snyder of the Kaiser Family Foundation authored this brief.

Executive Summary

Beginning in Fiscal Year (FY) 2014, policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth. This report provides an overview of Medicaid enrollment and spending growth with a focus on state FY 2015 and state FY 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA). Information collected in the survey on policy actions taken during FY 2015 and FY 2016 can be found in the companion report. Key findings related to Medicaid enrollment and spending growth are described in this report.

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016

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HMA Managing Principal Kathleen Gifford, Principal Barbara Edwards and Senior Consultant Jenna Walls authored this brief with Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.

The years 2015 and 2016 continue a period of significant change and transformation for Medicaid programs. With slow but steady improvements in the economy following the Great Recession, Medicaid programs across the country were focused on implementing a myriad of changes included in the Affordable Care Act (ACA), pursuing innovative delivery and payment system reforms with the goals of assuring access, improving quality and achieving budget certainty, and continuing to administer this increasingly complex program.

However, these changes to Medicaid policy take place in the larger context of states budgets. Unlike the Federal government, states generally have balanced budget requirements, taking into account the amount of revenue coming in from a state’s own resources as well as federal revenues. State lawmakers must balance competing priorities across budget expenditure categories. Even in years of economic growth, state lawmakers face this pressure of balancing priorities.

This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states:

Alaska
California
Tennessee

Michigan Medicaid Managed Care Results Announced

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In previous editions of The Michigan Update (most recently in August) we have reported on the Michigan Department of Health and Human Services’ (MDHHS) release of a Request for Proposals (RFP) to re-procure its Medicaid managed care contracts. The RFP was released in early May with bidder responses due in early August. This procurement is for at least five years, with the possibility of up to three one-year extensions. The total cost of the procurement for five years is estimated to be $35 billion. On October 13, 2015 the State of Michigan announced the much anticipated results of the re-procurement.

Since the prices paid to the contracted HMOs are set by the state, the health plan selection was based solely on technical scores. The HMOs were required to bid on entire regions, which were configured differently than in the past. The reconfiguration required a number of the HMOs to expand their service areas to meet the “entire region” requirement. The new regional configuration appears in the map below:

Note: Region 2 and Region 3 were required to be bid together.

The RFP included a proposed number of HMOs that would be awarded contracts for each of these regions. To minimize disruptions for Medicaid enrollees, in each region (other than the Upper Peninsula) the number of plans selected was one more than the proposed maximum number of awards for that region. Proposals from the HMOs were evaluated based on demonstrated competencies and also statements of their proposed approaches to many new initiatives related to population health, care management, behavioral health integration, patient-centered medical homes, health information technology and payment reform.

Not every HMO was successful in each region for which it submitted a bid. Two plans were not successful in any region. One is Sparrow PHP, which is an incumbent plan in Region 7. The other is MI Complete Health (Centene/Fidelis SecureCare) which is not currently a Medicaid plan in any part of the state but does have an Integrated Care Organization contract to serve dual Medicare/Medicaid enrollees in Macomb and Wayne counties as part of Michigan’s dual eligible demonstration.

The following table indicates the regions for which each bidding HMO was and was not successful. In addition, the numerical values show the rank of that plan based on their evaluation scores among the successful bidders for each region. If an HMO is a current contractor for all counties in a region, their result is shaded green. If the HMO is a current contractor for some but not all counties in a region, their result is shaded yellow. The number of Medicaid enrollees currently served in each of the regions, eligible through both “traditional” Medicaid and the Healthy Michigan Plan, appear in the bottom row on the table; across all regions, this is more than 1.6 million Medicaid enrollees.

Technical Evaluation Results

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HMA Principals Designated NCQA PCMH Certified Content Experts

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HMA Principals Lori Weiselberg and Lynn Dierker recently achieved the National Committee for Quality Assurance’s (NCQA) Patient-Centered Medical Home Certified Content Expert™ (PCMH CCE™) status.

NCQA is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Its certified content experts are required to complete two NCQA educational seminars, pass a comprehensive exam and commit to continuous learning and recertification to maintain the credential.

HMA’s team of NCQA Patient-Centered Medical Home Certified Content Experts™ includes Principal Linda Follenweider and Senior Consultants Melissa Corrado and Jodi Bitterman. HMA has deep PCMH experience and expertise — we’re ready to help your team.

	Region 1	Region 2	Region 3	Region 4	Region 5	Region 6	Region 7	Region 8	Region 9	Region 10
Aetna Better Health (CoventryCares)					No			Yes – 4	Yes – 4	Yes – 7
Blue Cross Complete				Yes – 3		Yes – 5	Yes – 3		Yes – 3	Yes – 5
HAP Midwest Health Plan						Yes – 6			No	No
Harbor Health Plan										Yes – 8
McLaren Health Plan		Yes – 3	Yes – 3	Yes – 4	Yes – 3	Yes – 3	Yes – 2	Yes – 3	Yes – 6	Yes – 4
Meridian Health Plan of MI		Yes – 1	Yes – 4	Yes – 5	Yes – 2	Yes – 4	No	Yes – 5	Yes – 5	Yes – 3
MI Complete Health (Centene/Fidelis)									No	No
Molina Healthcare of MI		Yes – 4	Yes – 1	Yes – 1	Yes – 1	Yes – 2	Yes – 1	Yes – 1	Yes – 1	Yes – 2
Priority Health Choice		No	No

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HMA Releases Medicaid Managed Care White Paper

The Value of Medicaid Managed Care

HMA’s Smith Part of NAMD Panel Reviewing Medicaid at 50

Report Examines Provider Network Monitoring Practices

Making Affordable Care Act Coverage a Reality: A National Examination of Provider Network Monitoring Practices by States and Health Plans

HMA’s Breslin Authors Primer on Medicaid Managed Care Capitation Rates

A Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs

Annual Survey Finds ACA Drove Record Annual Increases in Enrollment, Total Medicaid Spending

Medicaid Enrollment & Spending Growth: FY 2015 & 2016

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016

Michigan Medicaid Managed Care Results Announced

HMA Principals Designated NCQA PCMH Certified Content Experts

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