New Research Reports from North Carolina For Better Medicaid and Health Management Associates show the promising benefits of Medicaid Managed Care

(Raleigh, N.C., September 14, 2021) Today, North Carolina for Better Medicaid (NCBM), a coalition of dedicated health care advocates, released two new research reports prepared by Health Management Associates (HMA) showing how Managed Care has not only improved access to care for beneficiaries across the United States, but has also increased both the quality of care and beneficiaries’ use of preventive care programs. This new analysis documenting experiences with Managed Care in multiple states across the country, comes at a crucial moment as North Carolina transitioned to Managed Care in July.

 “The research reports released today provide encouraging data points for North Carolina policy experts, legislators, and community advocates and organizers who work every day to support Medicaid beneficiaries,” said Rhaegan Jackson, NCBM coalition representative. These reports showcase the ways Managed Care has positively impacted communities across the United States and demonstrates the potential for improved access and quality of care in North Carolina.”

The two research reports – “Impact of Managed Care on Access to Care” and “Impact of Medicaid Managed Care on Quality” – synthesize data from studies nationwide and experiences of state Medicaid programs across the country, contributing to the growing evidence base that suggests Managed Care improves access to care and quality for Medicaid beneficiaries. Key findings include:

  • Improved access to health care services including more office visits and medications filled – The Academic Pediatric Association found that from 2000 to 2017, for every additional 100 enrollees in Managed Care there was an associated increase of 36 beneficiaries with an EPSDT visit.
  • Improved use of preventive services - After transitioning to managed care, Louisiana saw significant improvement on numerous HEDIS measures, including access to preventive services, breast cancer screening rate, and well-child visits.
  • Decreased avoidable emergency department visits, inpatient stays and hospital readmissions – In Kentucky, avoidable inpatient stays, ER visits, and hospital readmissions were reduced after the 2011 implementation of Managed Care. In Florida, Managed Care beneficiaries had 7% shorter hospital lengths of stay than FFS beneficiaries, while Oregon saw emergency department use drop for all populations after it implemented a Managed Care incentive program in 2012.
  • Improved access to services and support to address unmet social needs – According to a 2017 Kaiser Family Foundation survey, 91% of MCOs reported activities to address social determinants of health and 93% of MCOs reported working with community-based organizations to link members to social services.

“These reports combine the experiences from various state programs and key data points on impact into one holistic story of Managed Care across the country,” said HMA Regional Vice President Kathleen Nolan. “The findings show how Managed Care can improve access and quality of care for Medicaid beneficiaries.”

Today’s reports also highlight that states that have shifted to Managed Care models are seeing improvements in quality in part because of increased accountability for quality performance with Managed Care models, use of care management services, and creative payment strategies that incentivize providing quality care in the right setting at a lower cost. The reports also found that when compared to FFS models, Managed Care created stronger relationships between beneficiaries and primary care providers focused on whole-person health, rather than one-off or uncoordinated visits.

You can find North Carolina for Better Medicaid on Twitter, Facebook and LinkedIn

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About North Carolina for Better Medicaid

North Carolina for Better Medicaid is a multi-stakeholder, consensus-based group of organizations committed to building a better Medicaid system that improves access, quality, outcomes and affordability in North Carolina. Our members include patient advocates, community-based organizations, health care leaders, health plans and others who are champions of Medicaid and Medicaid Managed Care. Current members include credible and diverse voices in healthcare including Mt. Zion Baptist Church, Mountain Projects Community Action Agency, I-CARE, Inc., the Economic Improvement Council, North Carolina Community Action Association, the North Carolina Black Alliance, the North Carolina Senior Living Association, the YMCA of the Triangle, NC Child, Blue Cross and Blue Shield of North Carolina (Healthy Blue), and UnitedHealth Group, who are working to ensure a successful transition to Managed Care and improve health care in the state. Learn more at northcarolinaforbettermedicaid.org

About Health Management Associates

The HMA team is over 225 colleagues strong and growing, with experience that spans the healthcare industry and stretches across the nation. Dedicated to serving vulnerable populations, HMA successfully tackles a wide variety of healthcare issues, working directly with federal, state, and local government agencies, health systems, providers, health plans, foundations, associations and others to effect change. Our colleagues have held senior level positions in medical and behavioral health provider systems, public health agencies, community-based organizations, state and federal agencies, managed care and accountable care organizations. We offer a breadth and depth of experience we believe is valuable to our clients in helping them achieve their goals and effect change. Founded in 1985, HMA is a private, for-profit “C” corporation, incorporated in the State of Michigan in good standing and legally doing business as Health Management Associates, Inc.

Contact:

Alex Sopko

North Carolina for Better Medicaid

asopko@apccoworldwide.com

202-631-2927