Managed Care Initiatives for Idaho Medicaid
Many states are implementing or considering managed care opportunities for their Medicaid programs. States have found the traditional fee-for-service model rewards increased service use, but does not address coordination of care, expanding access to rural areas, or focus on improving patient outcomes.
Idaho Medicaid utilizes a fee-for-service model for most benefits. Because of this and the difficult economic times over the last three years, Medicaid has relied on benefit and pricing reductions to sustain the program. Most people agree the State has exhausted these options; it’s time to consider restructuring Medicaid to be sustainable with the resources that are available.
In this effort to preserve Medicaid’s safety net services, Idaho is developing managed care programs that have the potential to improve patient outcomes and maximize the efficient use of taxpayer dollars. Idaho Medicaid currently has managed care programs for dental benefits, transportation, and primary care case management. Today, the program has several additional managed care initiatives under development. They include:
- Mental health and substance use disorder services;
- Coordination of care for people who have dual eligibility in both Medicare and Medicaid; and
- Medical home initiatives including Governor Otter's Multi-Payer Collaborative, pediatric medical homes under the Children's Healthcare Improvement Coalition and Medicaid Health Homes.
Comprehensive Care Management of Medical Services
Idaho Medicaid currently has 230,000 enrollees, growing 75% over the last ten years from 130,000 participants in 2001. It is the single, largest healthcare plan in Idaho. Looking to the future, Medicaid is poised to play an even greater role in healthcare coverage as Medicaid benefits expand to more citizens through the Affordable Care Act. With current federal and state budget discussions targeting Medicaid services, along with projections for increasing enrollments, Medicaid programs must be resilient in leading the way to innovative payment and delivery models.
With this in mind, Idaho Medicaid is engaging stakeholders to help identify the essential elements of an accountable managed care system that promotes cost-effective care and improved health outcomes. From studying other state Medicaid managed care programs, some of which date back to the early 1980s, the State realizes many of the lessons learned. These include over- or under-paid capitation rates to the managed care contractor; insufficient provider networks; poor planning for the transition to a managed care system; and poor oversight by states.
Along with identifying many of the pitfalls, other states’ experiences also outline many successes.
- Developing payment methods that incentivize quality, not quantity;
- Strengthening primary care with support for case management and care coordination;
- Improving access;
- Improving patient/family satisfaction
- Implementing evidence-based best practices that improve patient outcomes; and
- Reducing preventable emergency room use, hospitalizations or re-admissions.