News & Updates

Survey:  Value-based Purchasing Growing in Medicaid Managed Care;  Plans Experience Persistent Barriers to Behavioral and Physical Health Integration


September 19, 2019



Survey:  Value-based Purchasing Growing in Medicaid Managed Care;

Plans Experience Persistent Barriers to Behavioral and Physical Health Integration


Second annual Institute for Medicaid Innovation Survey shows benefits that Medicaid MCOs bring in value-based purchasing, behavioral health, other key domains

 

Washington, DC (September 19, 2019) – The nation’s Medicaid managed care organizations (MCOs) reported an increase in value-based purchasing arrangements which link medical provider payments to performance measures, and identified continued barriers to providing enhanced services to members with substance use disorder in the second annual Institute for Medicaid Innovation (IMI) national Medicaid MCO survey.

The survey also found that MCOs continue to place high value on targeted social determinant of health (SDOH) programs, designed to support members who may have obstacles preventing them from reaching optimal health. Plans often developed their own tailored screening tools to connect members with the right SDOH programs.

IMI, a non-profit, nonpartisan Medicaid research and policy group, released its second-year findings at the Medicaid Health Plans of America (MHPA) annual conference in Washington, DC today.

“The second year of data from the annual Medicaid MCO survey is starting to show distinct trends including an increase in the number of health plans implementing value-based purchasing arrangements.  We anticipate that there will be a continued upward trend in both value-based purchasing arrangements and dedicated resources towards addressing social determinants of health” said Jennifer E. Moore, PhD, RN, founding executive director of IMI. 

Furthermore, Dr. Moore shared that “ultimately, we hope that this and future reports will be able to inform the public, policymakers, clinicians, and researchers as we all work to improve access and coverage for the Medicaid population.” 

The survey collected information from Medicaid managed care organizations (MCOs) in eight critical categories, gauging the capabilities of the industry in these areas. Survey respondents represented 69% of all members in Medicaid managed care.

Notable findings from this year’s survey include growth in value-based payment models; identifying barriers in providing integrated services for members with behavioral health needs or social service gaps, such as transportation or child care; and coverage for complex populations, such as children with special health care needs.

Value-based purchasing models:  Results in the value-based purchasing category showed that the majority of Medicaid MCOs (95%) utilized an alternative payment model or value-based purchasing agreement in 2018, including incentive payments to providers for high-quality and cost-efficient care with 82% of Medicaid MCOs contracting directly with primary care providers.

Behavioral health services: Most Medicaid MCOs covered behavioral health services in 2018 and plans identified common barriers for behavioral and physical health integration. The most-referenced obstacle (88%) was data sharing limitations as a result of 42 CFR part 2.  This federal confidentiality law expands beyond  the traditional HIPAA regulations for those receiving treatment for substance use disorder. Most plans (82%) also noted that provider readiness to offer integrated physical and behavioral health support at point of care remains a challenge.

Social determinants of health: The majority (78%) of Medicaid MCOs offered targeted social determinant of health programs in 2018 for members, with the most common populations being pregnant women, individuals who are housing insecure, and adults with substance use disorder.

Children with special health care needs:  Nearly all health plans (95%) offered targeted child health programs in 2018, and more than 80% partnered with state Medicaid agencies to provide coverage for children with special health care needs (CSHCN).  The vast majority of plans provided an array of supports including coordinating with social services (93%), developing a comprehensive plan of care with family members (86%), and helping to arrange appointments with providers (86%).

A list of innovative programs from Medicaid MCOs regarding each of the eight surveyed service categories is available here.

 

Learn more about IMI’s prior research on behavioral health and social determinants of health

 

The complete IMI survey report may be found here.

 

Support for this project is provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the 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 information and analysis that informs Medicaid policy and improves the health of the nation.