How Medicaid Managed Care Plans Address SDOH, Expand Care Access

Medicaid managed care plans are innovating telehealth solutions and telehealth coverage, addressing social determinants of health, and improving access to care and informed provider selection for patients, stated a study conducted by the Menges Group on behalf of America’s Health Insurance Plans (AHIP).

AHIP has been very vocal about its support for Medicaid managed care organizations in the past.so

“Medicaid managed care plans collaborate with their state partners to deliver successful public private partnerships uniquely tailored to meet the needs of each individual state and the populations that are served by that state’s Medicaid program, proving that when the public and private sector work together, Americans get the quality and value they deserve,” the report found.

This latest study of proposal requests, model contracts, and work scopes from eight Medicaid programs and 14 Medicaid plan proposals from six states showed where managed care organizations are innovating.

One way in which Medicaid managed care plans had an advantage compared to fee-for-service plans was in managed care plan telehealth solutions, the report found.

Five of the states required telehealth coverage. This requirement covered primary care visits but also, in many cases, it also covered visits to specialists.

Most of the states were fairly hands off with this injunction. Only one plan made any specifications regarding the populations the telehealth tools must serve. Ultimately, Medicaid managed care plans centralized their efforts on:

• Telepsychiatry
• Remote monitoring
• Virtual urgent care
• Chronic disease management support

Medicaid managed care plans also provided support for social determinants of health. They accomplished this using four key strategies.

First, some Medicaid managed care plans identified when a social determinant of health barrier was hindering a patient’s healthcare and conducted referrals to the appropriate specialists. This involved integrated clinical, claims, and community data.

Second, food security was a priority among some health plans.

Providing financial relief to help patients shop healthier was one solution. Alternatively, some plans also enabled healthy grocery delivery through a mobile app for their beneficiaries. Still others coordinated community gardens or cooking classes.

Third, some health plans were especially attentive to home environments for children. These services identified adverse childhood experiences or enabled home visits that assessed other social determinants of health that children might be facing.

Finally, plans are offering job training and employment assistance for beneficiaries.

A study by the University of Michigan in February hinted at the already existent link between Medicaid and employment. By increasing Medicaid eligibility, states might actually improve employment levels among minority and low-income beneficiaries, the research suggested.

The country is seeing this correlation in even starker contrast with the coronavirus pandemic costing millions of Americans their jobs and employer-sponsored health plans. In a recent Urban Institute report, experts estimated that 50 percent of those who lose their employer-sponsored health plan could enroll in Medicaid, if the unemployment level hits around 20 percent nationwide.

With so many unemployed individuals funneling into Medicaid, having job search assistance and job training support built into Medicaid serves a pressing and timely social determinant of health for this population.

Finally, Medicaid managed care plans sought to support beneficiaries by expanding beneficiary access to care.

Medicaid managed care plans enabled patients to make more informed decisions about their provider by offering provider directory tools that displayed patient reviews of providers. They also were proactive in connecting patients with community resources.

The plans expanded patient access by expanding provider capacity. They provided extra support for providers in medical home healthcare and in coordinating risk arrangements and other quality improvement initiatives. Some providers received financial and grant assistance as well through a Medicaid managed care plan.

“Medicaid managed care plans are pursuing innovative programs that range from addressing social barriers to health to improving provider access, all in the service of providing enrollees with high-quality, affordable health care,” the report concluded.

"The data are clear. Medicaid managed care plan innovations far exceed anything available in fee-for-service Medicaid programs.”