July 27, 2021

Through Collaboration and Innovation, Managed Care Makes Medicaid Better in Ohio

To understand that Medicaid Managed Care companies are doing things differently, consider the views of physicians and hospital administrators — some of whom are not traditionally the biggest fans of insurance companies.

Dr. Sandeep Palakodeti, chief medical officer for population health at University Hospitals in Cleveland, praises the fact that the six private companies currently serving most of Ohio’s Medicaid patients are willing to put competition aside to tackle tough public health problems. He cites ongoing group efforts to reduce uncontrolled diabetes and screen more patients for lead exposure.

“Medicaid brought the managed care organizations together,” Palakodeti said. “Rather than competing against one another, we’ve seen collaboration.”

That collaboration — sharing data and agreeing on common initiatives and incentives for patients — just might be the best hope for making progress on stubborn problems that have confounded health-care providers for decades. In one current example, the six plans, with help from policy changes pushed through by the Ohio Department of Medicaid, have begun covering the cost of Diabetes Self-Management Education. If more Medicaid members know how to monitor their blood sugar and maintain healthy diets, more of them will be equipped and empowered to keep their blood glucose at safe levels.

Mark E. Schario, vice president for population health at University Hospitals, says the willingness of managed care organizations to innovate brings better results for patients. The plans all have initiatives aimed at addressing the social determinants of health — factors such as education, income and environment that can have a greater combined influence on a person’s physical health than medical care.

Schario pointed to a number of programs that provide high-speed internet access and digital devices to low-income members. “I think people are realizing that digital equity is actually health-care equity,” he said. “To even make appointments, let alone check labs, you need access. We don’t hear those concepts much from other (non-managed-care) lines of business.”

As chief medical officer of Dayton-area Five Rivers Health Centers, Dr. Mamle Anim helps oversee a sprawling operation with 240 employees over 13 locations handling 85,000 patient visits per year. She believes the constant push for improvement by the Medicaid Managed Care plans helps Five Rivers serve all its patients better.

CareSource, for example, convenes quarterly meetings of the centers’ leaders to review some important metrics. The target might be mammograms and pap smears or diabetes control. If the numbers don’t look good, Anim said, “The question is, ‘Why? What can we do to help you succeed?’ ”

That scrutiny helps the centers spot what otherwise could be invisible problems. “If we’re not measuring something, maybe we don’t realize we’re not doing so well,” she said. “We might just keep cruising, thinking we’re doing awesome.” When the CareSource-led review noted a high number of no-shows among Five Rivers patients struggling with hypertension, the MCO made a project of tracking them down and rescheduling.

The realities of serving the Medicaid population lend themselves to innovation and collaboration, according to Schario. For one thing, he said, the typically thin operating margins for Medicaid insurers mean “they have to get pretty creative about how they manage costs and programs.”

Beyond that, “This is not an easy population. There’s more churn — they move between plans more frequently.” Consequently, he said, the plans “all know it’s in their interest” to work together on common solutions. “They’re all going to see the same patients.”

Anim has been with the internal medicine clinic that is now a part of Five Rivers for 23 years — long enough to appreciate the difference that the advent of managed care has made. “I remember when I would have patients who couldn’t afford their medicines — they had to pick which one to get. They didn’t do their labs or go for testing because they couldn’t afford it.”

With Medicaid Managed Care, “That’s just not the conversation we have any more. We talk about how you can make your health better. We have the luxury of focusing on quality.”

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