Medicaid is the single largest source of health coverage in the United States, and the maternity population is no exception. In 2020, forty-two percent of births were financed by Medicaid. As these numbers increase year-over-year, states are relying heavily on managed care organizations to serve their Medicaid beneficiaries to improve the quality of care delivered and control costs.
Recently, Babyscripts served as an executive sponsor for the 2022 Medicaid Managed Care Summit in our home base of Washington, DC, which brought together Medicaid leaders from states and health plans, as well as government leaders and policymakers, to address the most pressing issues facing state Medicaid managed care.
Here are some of my key takeaways from the conference on the future direction of managed care:
Heavy focus on "whole person care". While it might seem like a buzzword, payers are looking at how to address as many risks as possible through housing, behavioral health, and of course clinical and social risks.
Is fee-for-service out? Value-based payments were a recurring theme in conversations and presentations. State Medicaid agencies are making a big push to standardize and encourage (or punish) providers for not doing value-based care. As we transition out of the pandemic (starting around 2023), we're going to see a rise in VBP. VBP models are often deployed in Patient Centered Medical Home (PCMH), Advanced Medical Home (AMH) or ACO models today.
It's all about the data. Public health agencies and payers are trying to get more data to run better models, more quickly and easily identify risk, and deliver more timely interventions. How to access and share that data continues to be a topic of focus.
Providers are taking on more responsibility. I heard a lot about unique models like those deployed in Massachusetts, where there is almost no MCO involvement and more than 75% of risk falls on providers through ACO models. We might see this taking off nationwide.
Who owns care management? There are some states that are stripping out care management from payers and putting it into local community or provider programs that can do more local outreach. North Carolina and Massachusetts are two examples of states that are doing it well.
Patient/Member experience and perception of care and service are key. These points are especially important as they relate to health equity. There will be financial implications for health plans related to this, and NCQA measures are currently being updated to focus on health equity measures.
Babyscripts also led a session at the conference, speaking on the application of technology as a means for converging the ecosystem of care into a patient-centric care model to bridge gaps and drive better outcomes within the Medicaid population. The session included a presentation of outcomes from LCMC Health in Louisiana, a state that scored an F on the March of Dimes Report Card for Maternal and Infant Health and has one of the highest maternal mortality rates in the country at 25.2 deaths/100K births.
Babyscripts' tech-enabled care coordination model enables MCOs to manage member care in collaboration with the provider, leveraging Babyscripts as a single platform to collect data around quality measures, communicate to and educate members, drive adherence to quality measures, and identify and triage risk faster. At LCMC Health, which serves a majority Medicaid population and is a beneficiary of this model, patients enrolled on Babyscripts were more than two times as likely to complete a postpartum visit in the first 30 days following delivery than the control group. By 60 days postpartum, 64% of Babyscripts users had completed a postpartum visit, compared to 44% of the control group.