/Innovations in Medicaid Managed Care Organizations

Innovations in Medicaid Managed Care Organizations

Managed Care Organizations

Medicaid managed care organizations are finding innovative ways to integrate physical and behavioral health services, including forging strong partnerships with community organizations, according to the Anthem Public Policy Institute.

Medicaid managed care has grown dramatically in recent years, now accounting for 73% of Medicaid enrollees. In tandem, the country’s largest insurers have reported significant growth in their Medicaid business lines.

In four new white papers, Anthem describes how MCOs are helping move the healthcare system away from the fragmented way in which physical health, mental health and substance use disorder care and services are paid for and delivered. This is crucial for the Medicaid population, as 1 in 5 beneficiaries have a mental health and/or substance use disorder (MH/SUD), and 60% of those individuals also have chronic physical health conditions, according to one white paper (PDF).

“MCOs can serve as the locus of coordinated care for beneficiaries by working with state Medicaid programs, mental health agencies, providers, members and their families, as well as community-based organizations that coordinate housing and other needs,” Jennifer Kowalski, vice president of the Anthem Public Policy Institute, said in an announcement.

Here’s a sampling of points from the white papers:

MCOs, including Anthem’s affiliated plans, are promoting integrated benefits and care through strategies ranging from “carving in” MH/SUD alongside physical health benefits to “fully integrating care in a way that holds payers and providers accountable for costs and outcomes.”

They are partnering with community-based organizations and developing more sophisticated tools and strategies for connecting members to resources that help them direct their own care. In doing so, MCOs have found that linking members to housing, education, employment and other needed support yielded successful outcomes for many individuals with mental health conditions and/or substance use disorders.

They are working with states and providers to promote effective, confidential information sharing through strategies such as establishing procedures for securing consent from Medicaid members to share their data, and supporting investment in and adoption of a more robust IT infrastructure for MH/SUD services and care coordination.

Increasingly, MCOs are looking toward value-based care models for individuals with mental health conditions and/or substance use disorders, as these models encourage primary care providers to conduct MH/SUD screening, intervention, medication management and treatment referrals.

In another recent white paper, the Anthem Public Policy Institute outlined new considerations for transforming quality measurement and reporting in Medicaid managed care arrangements.

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