The move away from fee-for-service medicine is moving beyond the experimental stage for private health plans that contract with state Medicaid programs, a new study shows.
The Institute for Medicaid Innovation’s 2018 annual Medicaid managed care survey said half of Medicaid managed care plans are “piloting population specific” value-based payment models and 15% are “expanding successful pilots.” The report was released during Medicaid Health Plans of America’s annual conference, which runs through Tuesday in Washington MHPA’s members include Aetna, Centene, UnitedHealth Group and WellCare Health Plans.
Health insurers and the government are increasingly moving away from fee-for-service medicine to value-based payment models that measure outcomes and stress population health strategies designed to make sure patients are getting care in the right place, in the right amount and at the right time. This trend is designed to keep people out of the hospital, shifting reimbursement to outpatient models and putting doctors and hospitals at greater financial risk.
The move toward value-based payment in Medicaid has been somewhat slower than the Medicare health insurance program for the elderly and commercial insurance where health plans say they are generally paying half of their medical spend via value-based models.
“Approximately 10 percent of managed care organizations surveyed reported that they had extensive arrangements in place in 2017,” authors of the report wrote in their analysis. “As barriers to adoption are removed, we anticipate an increase in the number of Medicaid managed care organizations transitioning from the pilot phase to fully implemented arrangements.”
The Institute said the Medicaid health plans responding to the survey provide coverage to more than 20 million people, or more than 44% of “all covered lives enrolled in Medicaid managed care across 34 states.”
Date: October 26, 2018