March 8, 2013
America’s Health Insurance Plans’ (AHIP) unveiled Tuesday (March 5) a 40-page report detailing wide-ranging efforts by Medicaid managed care plans to implement innovative programs that aim to improve care and reduce health care spending. The report, which industry notes comes at a time when lawmakers are looking at ways to improve care and save money, highlights plan efforts and achievements in three categories: working with community partners, addressing obesity, and caring for people with complex needs.
AHIP President and CEO Karen Ignagni says the report, Innovations in Medicaid Managed Care, could demonstrate to members of Congress that Medicaid health plans offer a compelling solution for states and federal governments who are looking at ways to reduce spending, and improve health outcomes. The report says it is industry’s hope that a review of best practices will be “especially productive” during this transition period for Medicaid, which could result in as many as 7 million more people enrolled in the program, even taking into account the Supreme Court decision that made the expansion optional.
She says the report shows that Medicaid plans have been providing “game changing” services and supports to vulnerable populations. It also shows that plans are already accomplishing the number one goal that the policy community has been talking about for low-income, disabled beneficiaries: Providing the supports and services to beneficiaries who want to be at a home, rather than in an institutional setting.
The amount of activity in that areas is “striking,” she says.
Care coordination, which the Medicaid plans pioneered, Ignagni says, is the best way of providing health care for vulnerable populations. “The consequences of not doing this are simply far too high to not have everyone in a health plan,” she says.
AHIP notes that more and more states have been relying on Medicaid managed care plans and as of 2011 about 50 percent of beneficiaries were in such plans. From 2010 to 2011, enrollment in Medicaid plans was nearly double traditional Medicaid enrollment ( 9 percent compared to 4.6 percent), according to the report.
The report also arrives as AHIP and other groups — including Medicaid Health Plans of America (MHPA) — are working to repeal the health law’s premium tax, which a Milliman report suggests could result in $38.4 billion more in federal and state health spending. Many states are looking to Medicaid managed care as they seek to align payments for beneficiaries eligible for both Medicare and Medicaid services, either via the demonstration or in other ways.
One plan, Medica, has been working with nurses and social workers who serve as care coordinators to help seniors enrolled in Minnesota’s Senior Health Options program for dual eligibles live independently at home, according to the report. The coordinators help seniors with a range of activities, including transportation, meals, adult day care, and “even services to mow the lawn and shovel the driveway.”
The coordinators sometime join members on doctors and other medical visits to help explain any medication instructions and ensure that all questions are answered.
Results show that from 2006 to 2012 the portion of members who lived in their own community grew from 39.4 percent to 71 percent. Other plans included in the “caring for people with complex needs” category focus on transitioning patients from care settings — including an Affinity Health Plan — that helps move people from in-patient psychiatric hospitals to home settings, and provides patients with more care choices, including a plan in Tennessee that allows patients or other representatives to hire personal care aides.
Passport Health Plan in Kentucky partnered with Louisville’s EMS services in a public-private partnership that came to being after EMS realized that many people called 911 services for non-emergency situations, which overwhelmed the system and threatened its ability to respond to true life-threatening needs. EMS applied for, and received, a grant from Passport to create a new Priority Solutions Integrated Access Management (PSIAM) intuitive that helps triage callers. People that do not have immediate need for an ambulance or fire services are transferred to a PSIAM nurse who asks questions based on “nationally recognized clinical standards” that determine the best way to respond.
“Our triage nurses are not only medical professionals but they’re care navigators, patient advocates, negotiators, transportation coordinators, salespeople — it’s a unique combination of skills,” Kristen Miller, chief of staff of Louisville EMS, says in the report. “With a little guidance and confidence on our end of the line, most patients realize that it’s a tool that’s there to help them, not simply remove them from the 911 system.”
The report says that since 2011 the program has served more than 1,200 callers with non-emergency conditions, and saved patients an estimated 30 percent in transportation costs from 21010 to 2011. The city made the program permanent, and this year Louisville was one of five cities to get funding from Bloomberg Foundation to help improve customer services. The city plans to expand the program by adding weekend hours, hiring another nurse, adding a direct phone line and offering case management services for chronic care patients who frequently call EMS.
Health Partners in Philadelphia is one of the plans highlighted for its work to address obesity for it’s “Biggest Winner” nutrition program launched in 2009.
For the program, the health plan offers a 13-week session during which beneficiaries are counseled on ways to improve nutrition and pay attention to calories. The program is small — 46 people completed the sessions in 2011- but the report notes that most of the people who finished it lost weight or reduced triglyceride or blood sugar levels. Other programs touted in the report offer community and family fitness classes, nutrition educations and other tools that have helped people to lose weight and control diabetes and other medical issues.
Ignagni says that AHIP decided to put the report together last summer as part of an innovation series, which has previously focused on plan innovations in health information technology, Medicare Advantage and other subjects but had not probed Medicaid plans for a while. She says she was not surprised by the number of innovative programs offered by the plans, but that reading the report with all of them put together tells an important story. — Amy Lotven
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