Care coordination models matter. The approach that a payer takes to care coordination fundamentally changes the service delivery system—and provider reimbursement. For specialty provider organization executive teams, understanding the care coordination models preferred by payers is critical to strategy, referral generation, revenue and growth, reimbursement, and marketing planning.
To help get a bead on the issue, our team conducted an analysis of the Medicaid care coordination models used in each state in our new report, State Medicaid Care Coordination Initiatives: The 2019 Update. We looked at seven models ranging from models that change provider roles within the existing system such as patient-centered medical homes (PCMH), health homes, and certified community behavioral health centers (CCBHCs) to models that restructure the basic financing of benefits like accountable care organizations (ACOs), managed long-term services and supports (MLTSS) plans, dual eligible integration initiatives, and vertical/specialty health plans.
What did we find? The most common model was PCMHs in 30 state Medicaid plans. There are MLTSS plans in 22 states and health homes in 21 state Medicaid plans. The models that are least common are Medicaid ACOs, dual demonstration initiatives, and CCBHCs (note that CCBHCs are limited to the states that received grants).
What is the general direction of Medicaid care coordination? There are a few recent developments to consider. First, four states (Arkansas, California, West Virginia, and Illinois) added specialty consumer health plans in the last year. Funding for CCBHCs keeps getting short-term extensions, but we are still waiting to see if Congress will expand the program (see House delays DSH cuts until December). An increase in “health homes” is likely with the child-focused health home initiative starting in late 2022 (see CMS To Launch Health Homes For Children With Medically Complex Conditions).
Each of the integration models adopted by Medicaid have specific opportunities and strategic challenges for specialty provider organizations. The creation of new health plans—MLTSS plans, specialty consumer plans, and Medicare-Medicaid dual plans—bring new consumers into the managed care-oriented service delivery systems. This increases the share of health care spending in local markets that is controlled by health plans. The expansion of ACOs typically shifts health care spending to hospital systems, and the expansion of medical homes and health homes concentrates care coordination in a smaller group of provider organizations.
To learn more about your state Medicaid plan and their care coordination models, check out our new report, State Medicaid Care Coordination Initiatives: The 2019 Update. The report contains a chart detailing which states have PCMHs, health homes, CCBHCs, ACOs, MLTSS plans, dual eligible integration initiatives, and vertical/specialty health plans. These care coordination initiatives are compared to 2018 and changes in adoption explained.
And, to learn more about each of the care coordination models, check out these resources in our OPEN MINDS Circle Library:
- Patient-centered medical homes – see Medical Home For I/DD Consumers Reduced Health Care Costs By 8.7% and Integration Strategies For The Complex Consumer Market
- Health homes – see Health Homes For Children—The Next Wave? and The Nuts & Bolts Of Making A Health Home Sustainable
- Certified community behavioral health centers – see What Is The Future Of The CCBHC? and Successfully Managing Bundled Rates—The Voice Of Experience
- Accountable care organizations – see ACOs Saved Medicare $1.7 Billion In 2018 and The Growing Push For Medicaid ACOs
- Managed long-term services and supports plans – see The Medicaid MLTSS Market Shift and In Managed Long-Term Care, Whole Person Takes One Step Further
- Medi-Medi dual eligible integration initiatives – see The Path Forward In Serving The Dual Eligible Population and CMS Forwarding Three Opportunities For State Integrated Care For Dually Eligible Individuals
- Vertical/specialty health plans – see The Medicaid Vertical Carve-Out Model Comes To I/DD and The Medicaid Vertical Carve-Out Landscape: The 2019 OPEN MINDS Update
And join us at The 2020 OPEN MINDS Performance Management Institute in Clearwater Florida on February 12 for the session, The OPEN MINDS Integration Summit: New Models For Primary Care, Behavioral Health & Social Service Integration featuring Donald Parker, LCSW, President, Hackensack Meridian Health Carrier Clinic; Lisa Kay, Clinical Program Manager, Cigna; and Tine Hansen-Turton, President & Chief Executive Officer, Woods Services, Inc.