How Medicaid Managed Care Orgs Can Confront Care Disparities

Reducing racial care disparities and promoting health equity are key functions of Medicaid managed care organizations, particularly in the context of the coronavirus pandemic, an issue brief from America’s Health Insurance Plans (AHIP) emphasized.

“As leaders come together to make real progress toward this shared commitment, Medicaid managed care organizations (MCO) are a proven valuable partner for creating tailored solutions that work, utilizing insight from deep experience working with people who rely on Medicaid, and building on strong community partnerships to meet people where they are,” the issue brief began.

AHIP noted eight ways in which Medicaid managed care organizations can confront health inequity.

The coronavirus pandemic has disproportionately impacted communities of color across the US. It amplified the disparities in healthcare coverage as millions of people of color lost their employer-sponsored health plans due to the pandemic-induced recession.

As a result, many Americans have turned to Medicaid, placing Medicaid managed care organizations at the front lines of enforcing health equity and reducing care disparities in healthcare coverage.

Maternal health outcomes are also deeply segregated. For example, in Chicago, Black mothers are almost six times as likely to die due to pregnancy-related causes as White mothers.

To address these disparities, Medicaid managed care organizations improved preconception planning and awareness, sought to identify high-risk pregnancies early, incorporated coordinated care, covered preventive screenings and contraceptives with zero cost-sharing, and more.

Medicaid managed care organizations also found a space to support health equity by providing care for children with complex conditions. Preventive services helped detect the diseases early or administered protection against these conditions.

Also, care coordination has proven essential to providing high-quality care in general, but it is particularly influential for children with complex or rare diseases.

Social determinants of health have also played a role in motivating the surges in racial health disparities during the coronavirus pandemic.

Medicaid managed care organizations have leveraged various tactics to help reduce social determinants of health for disadvantaged communities.

For example, some organizations screened for social determinants of health and offered referrals based on the results. Data analytics assisted in identifying neighborhoods and populations that were particularly afflicted by certain social determinants of health factors.

Community directories made support more accessible and programs and partnerships addressed immediate needs. The Medicaid managed care organizations also invested in technologies that eased communication with the social service industry.

Infrastructural investments are an underrated but important component of overcoming socioeconomic challenges, experts agree. Some Medicaid managed care organizations have set aside reserve funds to purchase affordable housing or to transform buses into mobile supermarkets.

Medicaid managed care organizations have also fought health inequity and sought to reduce care disparities through their employment strategies.

Organizations leveraged their community advisory boards to accurately assess the community’s needs.

Medicaid managed care organizations also employed a diverse set of healthcare professionals, often drawing candidates from the communities themselves.

“Medicaid MCOs also employ diverse members from the local community in critical provider, community health worker, outreach, care management, doula, and peer support roles. Through this engagement, Medicaid MCOs help ensure that people with strong community connections and with relevant lived experience can empathize with members and address their needs,” the issue brief explained.

Rural healthcare can often see high care disparities related to access to care, particularly during the coronavirus pandemic as rural healthcare facilities buckle under economic pressures.

Medicaid managed care organizations have supported telehealth and remote technology options in order to expand access to care in rural communities. They also tried to draw more healthcare professionals to rural regions using financial rewards. The payers also offered financial support and new payment models to struggling facilities.

Telehealth quickly became a tool to improve access to care during the coronavirus pandemic, which has had a mixed effect on racial care disparities. It has been especially useful for providing vulnerable populations with access to behavioral healthcare services.

Hotlines for health and socioeconomic resources and provider finder online tools are just a couple of ways in which Medicaid managed care organizations sought to lower racial care disparities using technology. They have also grappled with the growing digital divide that resulted from this surge in telehealth utilization.

Finally, Medicaid managed care organizations assess quality measures to ensure health equity. Using data analytics, they identify any gaps in the system. They leverage financial incentives to improve quality of care. As a result, Medicaid managed care organizations saw improvement on 87 percent of key quality measures between 2014 and 2018.

There are still improvements to be made to this quality of care approach, specifically related to measuring health equity. To that end, one of the foremost quality measurement organizations—the National Committee for Quality Assurance (NCQA)—has released recommendations on digital quality measures for health equity.

“This is a seminal moment for racial and social justice and greater diversity, equity, and inclusion,” AHIP concluded. “Medicaid MCOs believe we have an urgent mandate to reform our health care system so everyone in America has an equal opportunity to thrive and achieve their best health.”