Anthem Public Policy Institute says policymakers can learn from Medicaid MCO innovations

September 14, 2015

A white paper from the Anthem Public Policy Institute contends that states that want their Medicaid programs to better serve the growing number of beneficiaries should look to some of the innovative solutions employed by Medicaid managed care organizations (MCOs). The paper states that MCOs have come up with strategies to maintain strong relationships with providers and enhance their provider networks. The paper provides an overview of the three main initiatives:

  • Innovative use of technology: Telehealth holds "much promise" to expand healthcare access in underserved geographic areas and in certain disciplines, and many MCOs also developed outreach strategies that use mobile technology to educate members on chronic conditions, to send screening reminders and even consult with members who fail to file critical prescriptions;
  • Care delivery and payment reforms: Medicaid has been fundamentally transformed by the rise of PCMHs, care coordination models, data-driven population health management efforts, ACOs and the shift from volume-based to value-based payment models; and 
  • Support of non-traditional providers: Some Medicaid plans are allowing physician assistants, nurse practitioners and advanced-practice nurses to be credentialed as primary care providers, while some medication therapy management programs feature pharmacists working with other members of the care team to achieve the best results from patients' medication therapy. Additionally, many Medicaid plans have integrated retail clinics into their provider networks to offer their members convenient care alternatives.