Why Michigan Should Expand the Managed Care Model in Medicaid

High quality is the gold standard in healthcare. A new study looking at measurable outcomes finds that managed care – where an insurer is required to work with all of an individual’s healthcare providers to ensure the best care is delivered at the right time by the right provider – are more efficient than the old paid services. – service system.

Health Management Associates (HMA), a national healthcare research company used by government and private sector entities to identify trends, statistical data and measurable health policy outcomes around the world, led the ‘study.

For many years, the fee-for-service model, in which physicians and providers are reimbursed a flat, flat fee for each service performed, was common across the country. However, the past 40 years has seen the growth of a more innovative healthcare delivery model, known as managed care, where health plans create a network of providers and physicians to manage quality outcomes. patients and competitively set provider reimbursement rates.

Managed care became more mainstream in the early 1980s to better monitor spiraling costs and measure patient experiences, outcomes and preferences. Today, most of the commercial employer-sponsored health care market operates under a managed care model. Traditionally, government-run programs like Medicare and Medicaid have used a fee-for-service model to deliver healthcare services, although Michigan has been a leader in using private managed care organizations to obtain better results in terms of quality, access and cost.

In health insurance, Medicare Advantage, a managed care alternative to paid health insurance, is gaining popularity. Nearly half of Medicare customers now select a Medicare Advantage plan to coordinate and administer their Medicare-covered benefits through a managed care network.

With this history, HMA compared paid Medicaid programs to managed care programs to determine which offered the best quality. The study found that managed care provides better quality outcomes and has a more positive overall impact on quality of care for the Medicaid population across the county than fee-for-service.

Managed care providers reach out to their members, especially vulnerable populations on Medicaid, to ensure they take prescriptions, get key screenings for procedures like breast cancer, pregnancy, or colon cancer. The study also highlights how managed care does a better job of handling emergency follow-up hospitalizations for mental illness and monitoring patient adherence to medication.

Managed care providers identify services that are provided by low-cost but high-quality providers, and negotiate with providers to control costs fairly. They use the data to see if the services provided are medically necessary. According to the study, value-based payment schedules between providers and health plans, as well as performance-based metrics between managed care states and health plans had a significant impact on improvement. outcome measures.

Bottom Line: When comparing these health care delivery systems in the Medicaid population across the county, managed care outperforms fee-for-service in every benchmark (child, adult, preventative health, women’s health , disease management and behavioral health).

Michigan is currently in discussion about whether to move its Medicaid-paid behavioral health services to an integrated managed care system. The data is clear: patients will receive better care, and the state will be able to provide more services at a similar cost, if it chooses integrated managed care over the current fee-for-service system run by the government.

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