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IMI Releases 2020 Annual Medicaid MCO Survey Report Showcasing Data from Nearly Every State Across Eight Categories


December 8, 2020



IMI Releases 2020 Annual Medicaid MCO Survey Report Showcasing Data from Nearly Every State Across Eight Categories

 

Washington, DC – 93 percent of Medicaid health plans reported using value-based payment (VBP) or alternative payment models (APMs) in 2019. Given the increasing interest in linking payment to quality and outcomes in health care and reducing volume incentives, attention to VBP and APMs has grown over recent years. As the Medicaid program serves a high proportion of individuals with long-term health needs, Medicaid managed care organizations (MCOs), serving almost 70 percent of all Medicaid members, have often turned to VBP to manage costs while ensuring optimization of health outcomes and quality of care.

On December 8, 2020, the Institute for Medicaid Innovation (IMI), a non-profit, nonpartisan research and policy organization, released its third annual Medicaid MCO survey report, Medicaid Access and Coverage in 2019 . The survey collected data on Medicaid MCOs, representing 67 percent of all covered lives in Medicaid managed care across almost every state, in eight critical categories, demonstrating the capabilities of the industry in these areas. These categories include behavioral health, child and adolescent health, high-risk care coordination, managed long-term supports and services, pharmacy, social determinants of health (SDOH), value-based purchasing, and women’s health. The survey has been conducted annually since 2017, allowing for comparative, longitudinal data from the past three years.

The survey findings portray consistently high utilization of VBP and APM arrangements among Medicaid MCOs, with 93 percent reporting using VBP or APM structures in 2019. Only 79 percent reported that state contracts required implementation of VBP contracting with providers in 2019, demonstrating initiative from MCOs to implement arrangements without being contractually obligated. Although overall, utilization of VBP arrangements has been consistent across the three years of the survey, implementation has varied over time within specific provider categories. Implementation of VBP arrangements with dentists has increased over the past three years, while arrangements with home and community-based services providers, long-term care facilities, and orthopedics have declined.

In additional to unique, longitudinal data regarding VBP, the survey report also offers insight into the Medicaid managed care industry, such as the high engagement in addressing SDOH for Medicaid members. All health plan respondents offered targeted SDOH programs in 2019 and primarily focused on individuals who are homeless or housing insecure (87%), pregnant (73%), and/or with serious mental illness (67%). Notably, health plans do not consistently use the same screening tool to assess member SDOH needs. Half of respondents indicated using an internally developed or adapted tool and 13 percent indicated not using a tool at all. Health plans still face multiple barriers to serving member SDOH needs including capacity of community-based organizations and unsustainable resources.

More survey results can be found in the newly released annual survey report, Medicaid Access and Coverage in 2019, which can be accessed and downloaded here. Additional resources such as graphics that can be used can be accessed here.

The 2020 annual Medicaid MCO survey report was produced with support from the Robert Wood Johnson Foundation.

 

About the Institute for Medicaid Innovation

The Institute for Medicaid Innovation (IMI) is a 501(c)3 nonprofit, nonpartisan research and policy organization that provides independent, nonpartisan information and analysis that informs Medicaid policy and improves the health of the nation.

 

Media Contact

Lydia Tonkonow

ltonkonow@medicaidinnovation.org