Altarum's Private Insurance Research Collection

Commissioned Projects

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Going Beyond Traditional Medicaid Managed Care Contracting: Early Results From States Contracting With Provider Networks, Allan Baumgarten, LLC

The expansion of Medicaid eligibility by 34 states has resulted in 12 million Americans not previously eligible gaining Medicaid coverage and better access to health care. In most of the expansion states, the state Medicaid agency contracts with managed care organizations (MCOs) to serve as intermediaries, contracting with providers and paying them for services provided to Medicaid enrollees. Under those contracts, the MCOs accept financial risk to arrange that enrollees receive all covered services as needed. We are currently conducting research supported by the Robert Wood Johnson Foundation to examine the financial performance of the Medicaid MCOs and to identify effective practices by state agencies in setting the terms of contracts with MCOs and overseeing their performance under those contracts. That research focuses on states that are contracting with MCOs on a full-risk basis, which is the predominant model today. This proposed research would focus on specific states, including Colorado, Massachusetts, Minnesota and Oregon, that are moving beyond the traditional managed care strategy and are contracting with provider systems on a limited- or full-risk basis (some calling it Medicaid Accountable Care Organizations) and reducing or eliminating the middleman role of the managed care companies. We would report the initial results of those strategies and discuss their implications for states seeking to gain additional value from their Medicaid managed care programs. In addition, we would add data from 2018 operations for MCOs in selected states and conduct follow-up interviews with Medicaid agency and MCO leaders in those states. 11/1/18 – 7/1/19