Medicaid managed care has changed monumentally in the last three decades, from a system that was focused on managing costs to the managed care of today which is making demonstrable differences in patient care and health outcomes.
Medicaid is a foundational component of America’s health delivery ecosystem — serving 72 million Americans and accounting for 18% of total health care expenditures. The Medicaid program is a partnership between states and the federal government that ensures minimum requirements are met, while ensuring states have the flexibility to design programs that work for their populations, providers, and priorities.
More than two-thirds (69%) of all Medicaid beneficiaries in the country receive their care through managed care organizations[i]. Medicaid managed care organizations can look beyond the standard set of health benefits covered by Medicaid to also provide supportive services. Under this approach, holistic care is delivered for the beneficiary and there are potential cost savings to the state. These can include things from weight loss coaching to home modifications that help keep people in their home and out of a nursing home setting.
“Addressing the social determinants of health are becoming an increasingly important focus to improve the overall health of Medicaid beneficiaries,” said Catherine Anderson, senior vice president at UnitedHealthcare Community and State. “Providing people with things like access to healthy low-cost food or support to find stable housing can ensure better long-term health — and these are things managed care organizations are uniquely positioned to do.”
In a 2019 survey of Medicaid managed care plans, all said they had programs addressing social determinants of health. Medicaid managed care organizations are better equipped to determine population needs, and better positioned to be able to address these issues. Providing additional resources for these individuals makes it easier for them to access care and focus on their health. This approach to Medicaid managed care can bring together disparate parts of the health care and social service systems to best serve patients.
This ability to bring together different parts of the health care system is coupled with improved access to primary care providers for beneficiaries in Medicaid. Improved access to providers is good for both providers and their patients, and it’s not the only way managed care is working to make improvements. With value-based contracting programs, which reward providers for quality patient care, managed care is also supporting providers in their mission to deliver better health outcomes for patients.
All of this is done while shifting the risk of unpredictable budgets and the rising cost of medical care to managed care organizations. This is especially important as state budgets and revenues have become even more unpredictable because of the COVID-19 pandemic, and many states are facing shortages. It is estimated that Medicaid managed care saves states $7.1 billion annually[ii]
Modern Medicaid managed care works to keep patients healthier, provides access to services that target social determinants of health, and makes budgets more predictable for states. For more information about what UnitedHealthcare is doing to support members in Medicaid managed care visit, www.uhccommunityandstate.com.