Medicaid
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Medicaid enrollees asked state for more collaboration from managed care plans and providers. Will they listen?

January 13, 2020
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Each time the Ohio legislature deliberates the state’s $65 billion biennial budget, its members are translating the power granted to them through elections into policy, appropriating dollars on behalf of the 11 million Ohioans who are served by the state government. It is true most of the resources budgeted for Medicaid come from the federal government, with nearly 4 in 5 dollars provided through taxes or by the feds. What’s ultimately truer, however, is that all the resources come from taxpayers. And, in the end, the responsibility of the Medicaid program, as it pays the providers who deliver care, is to ensure that these resources connect people to high-quality medical care, when they need it, in an efficient way.

It is true most of the resources budgeted for Medicaid come from the federal government.

We’ve previously written about how significant Managed Care Organizations (MCOs) are in Ohio’s Medicaid program, and responsible for 1 in 3 dollars the legislature budgets. The reason to invest in a managed care model is logical, in theory: MCOs have the ability to individually negotiate contracts with providers, hire medical staff and leverage data to manage their risk. When they do so effectively, they are rewarded with the savings they produce. Additionally, the state is able to dictate to these companies how they want this relationship to work, defining its expectations for outcomes, costs, quality and consumer engagement. So, what has been the result of this investment? [bctt tweet="#Medicaid Managed Care Organizations are supposed to connect people to high-quality medical care but are they?" username="CommunitySols"]

According to the last external-quality review of MCOs, no single plan met all minimum performance standards in 2018. And, in the latest “report card” issued by the state, where each of the five MCOs have five areas of evaluation, 17 out of the possible 25 scores were average or below. It should be noted, however, the efforts by plans to improve quality have been evident, with many areas of measurement progressing as Ohio has implemented value-based payments. But, given the current, largely average, performance the state is appropriately renegotiating this relationship, and has opened the contract with managed care to new bidders.

In the latest “report card” issued by the state, where each of the five MCOs have five areas of evaluation, 17 out of the possible 25 scores were average or below.

As a part of this process, the state issued a request for public comments and conducted outreach with in-person focus groups they termed “listening sessions.” Hundreds replied to the request for feedback. The state engaged 119 individuals in the fall, in 17 sessions spanning 13 counties and partnering with 36 organizations to promote the sessions (including The Center for Community Solutions). The state did not have to engage in this outreach process as a condition of rebidding, but did and the results of the feedback are interesting.

The state did not have to engage in this outreach process as a condition of rebidding.

For the formal public comment, many professional organizations highlighted the need to improve the relationship between providers and plans, focusing in on shared coordination responsibility, administrative simplification and access to data. Interestingly, for individuals who engaged in the listening sessions, many of the same themes emerged, especially as it relates to better coordination between providers and community-based supports. And while this feedback is important and useful, the state will collect feedback throughout the process, and has created a website to do that and publish up to date info as it becomes available.

What comes next is perhaps the most consequential step. The data shows that managed care, while improving, could be doing more to achieve value. However, it is equally important to remember that the providers delivering care are equally responsible in that mission. The state’s role, then, is not only to keep managed care accountable to the taxpayers, but to also ensure the providers who make money in this system are held to the same standards of effective and efficient care.

Some of this renegotiation may mean the market fundamentally shifts and allows providers to integrate insurance products into their businesses. And there is some evidence to suggest that this sort of model can produce savings and improve outcomes. However, greater market control does not necessarily mean that quality always improves and there is other evidence to suggest that consolidation can even diminish quality and harm patients. So what’s the answer?

Despite all the billions of dollars going to MCOs, hospital systems and other providers, advocates and beneficiaries feel like more can be done.

I’m not sure if there is one answer, but I will look at what the state says when it issues its final request and then how those responses go beyond meeting the basic regulatory standards. Specifically, I want to see proposals that more meaningfully encapsulate the issues and concerns brought forward in the public-input process, particularly from the people who are served in the program. That is the value of such a process. And what that process revealed is that, despite all the billions of dollars going to MCOs, hospital systems and other providers, advocates and beneficiaries feel like more can be done. And, since we’re all ultimately paying for the program, we should expect more collaboration and integration, and less self-interest.

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