Task Force Hears Testimony on MO Managed Care

At the Task Force for Examining Statewide Medicaid Delivery Models’ final meeting of 2015, the Mo HealthNet Director presented on Missouri’s current managed care program.

Medicaid in Missouri is delivered through both fee-for-service (FFS) and managed care models. Dr. Joe Parks provided task force members with a comparison of these systems based on cost, utilization, and performance. Between FY2010 and FY2013, managed care saved an average of 1.7% compared to fee-for-service. Patients in managed care had fewer hospital admissions and shorter hospital stays but more hospital readmissions and emergency room visits. Managed care performed better on eight of the clinical quality measures, and fee-for-service scored higher on 10.

Dr. Parks also walked through some of the cost-containment and quality improvement initiatives added to the FY2016 Mo HealthNet managed care contracts. Plans are to develop member incentives that encourage patients to exhibit healthy behaviors and use healthcare services efficiently. In September, plans were to submit plans to Mo HealthNet for provider incentive programs to reward those who improve health outcomes and reduce unnecessary utilization. Mo HealthNet wants plans to increase the use of these incentives by 10% over the regional baseline.

MCOs are also required to submit plans for Local Community Care Coordination Programs (LCCCP) by the end of 2015. LCCCP must use models that provide care coordination, case management, and disease management through local providers, such as ACOs, patient-centered medical homes, health homes, or primary care case management.

To improve compliance with contract provisions, Mo HealthNet is withholding 2.5% of plans’ capitation payments each year until they meet benchmarks on encounter data accuracy, provider panel accuracy, EPSDT completion rates, case management, member and provider incentive programs, and LCCP.

Patient access to providers and the accuracy of MCOs' provider information is an area of concern. Dr. Parks discussed the results of a secret shopper survey conducted to gauge the correctness of the provider information on plans’ websites. The accuracy of their provider directories ranged from 44% to 80% for primary care providers and 43% to 63% for psychiatrists. The percentage of providers on the list who were accepting new Medicaid patients ranged from 42% to 72% for primary care and 26% to 63% for psychiatrists.

Finally, Dr. Parks gave an overview of the responses submitted to Mo HealthNet’s RFI on managed care expansion. Thirty-four entities, including MARHC, offered feedback on the RFI. While the responses varied, common themes included the importance of care coordination, technology as a care management tool, and incentives based on health outcomes.

The task force co-chairs, Sen. David Sater (R-Cassville) and Rep. Marsha Haefner (R-Oakville), have not determined if more meetings will be held after the New Year.

For more information on the hearing, you can view the PowerPoint summarizing RFI responses here and Dr. Parks’ presentation on Mo HealthNet managed care here.