TX Medicaid Managed Care Practice: Reducing Costs and Improving Care

In recent weeks, Texas legislators have been calling attention to the need for greater flexibility from the Administration to reform Medicaid in Texas. Specifically, Lt. Governor Dan Patrick and Senator Charles Schwertner (R-Georgetown), hosted a press conference on March 2 in Austin to announce a letter to President Obama signed by the Texas Senate’s 20 Republicans pressing for changes to reduce costs and boost flexibility.

TAHP supports efforts to gain greater flexibility from the federal government to steer Medicaid onto a sustainable financial path. Greater flexibility has already proven to lead to lower costs. Current trends indicate that, in adopting the managed care approach and taking advantage of its inherent flexibility, Texas has taken important steps to reduce costs under Medicaid. Recent studies, commissioned by TAHP and carried out by nationally respected health care research firms Milliman and Sellers Dorsey, found thatthe Medicaid managed care approach has saved Texas nearly $4 billion over six years, compared to projected expenses under the fee-for-service (FFS) model it replaced. In addition, projections indicate the managed care approach is expected to save an additional $3.3 billion over the next three years.

Specific Findings

The Milliman and Sellers Dorsey studies found that Texas Medicaid MCOs have effectively utilized the flexibility at their disposal to implement innovations that have improved community access to health care services, reduced unnecessary hospitalizations, improved the quality of beneficiaries’ lives, and increased competition by rewarding providers for enhanced performance.

A few examples highlighted in the study are below:

• Cigna HealthSpring implemented an intensive behavioral health intervention that reduced the overall costs for the top 5 percent most expensive members by 40 percent.
• Superior Health Plan’s Integrated Diabetes Program was implemented in 2011 and focused on care management intervention upon discharge for foster children with multiple diabetic admissions. This intervention reduced the Diabetes Short-Term Complications admission rates by 45 percent. It also reduced the rate of 30-day readmissions after diabetes-related inpatient stays from 55.7 percent to 14.1 percent.
• Parkland Community Health Plan collaborated with local community based efforts to improve asthma care for patients of all ages, including the initiation of home visits by respiratory therapists for the most severe asthmatics. This program has resulted in significant decreases in ER visits and admissions for asthma.

Not only has managed care improved outcomes, it has also made life easier for people who utilize it. In fact, 83% of families with children in managed care report an overall positive experience with their MCO and 93% of families with children in Medicaid managed care report having access to their primary care provider. When you’re a parent with a sick child, that kind of reassurance can make all the difference in the world.

With More Flexibility, A Brighter Future for Medicaid

TAHP’s research confirms that not all of Medicaid is broken. With important reforms and greater flexibility, Texas has the opportunity to steer Medicaid onto a sustainable financial path that saves taxpayer dollars, improves access and quality of care, increases options, and enhances the overall quality of life for Medicaid beneficiaries. The Medicaid managed approach has moved Texas toward the goal of keeping beneficiaries healthy, reducing unnecessary care and expenses, and making critical services more affordable and accessible.

TAHP will be working to strengthen the managed care approach and secure greater flexibility to ensure its continued success.

HHS Enrollment Snapshot

On Tuesday, March 10, HHS announced that 1,205,174 Texas consumers were automatically re-enrolled for coverage through the federal law as of Feb. 22.  In 2014, 733,757 people enrolled in the program throughout the state. It represents a 64 percent increase statewide.

Of the Texas consumers with a marketplace plan, 85 percent — 1,036,450 people — qualified for an average tax credit of $239 per month and 68 percent paid $100 or less per month after tax credits. In Texas, 92 percent of individuals with a marketplace plan selection had the option of selecting a plan for $100 or less per month.

In Texas, 468,797 consumers under the age of 35 are signed up for Marketplace coverage (39 percent of all plan selections compared to 38 percent of plan selections at the end of 2014 Open Enrollment). And 348,593 consumers 18 to 34 years of age — 29 percent of all plan selections — are signed up for Marketplace coverage. (Source: Dallas Morning News)

HEALTH PLAN MEMBER HIGHLIGHTS

Texas Physicians to Benefit from First-Of-Its-Kind Organization Created by Blue Cross and Blue Shield of Texas, Texas Medical Association

On February 5th, Blue Cross and Blue Shield of Texas announced it has partnered with the Texas Medical Association to launch TMA PracticeEdge, LLC, with the goal of empowering a strong base of independent physicians to provide quality, cost-effective care to their patients. This first-of-its-kind joint effort leverages the strengths of TMA’s statewide physician membership, 48,000 Texas physicians, and BCBSTX’s resources to benefit the entire Texas health care community, including patients, hospitals, payers, and other physicians.

TMA and BCBSTX share the goals of increased quality and cost-effective care found in existing physician-led accountable care organizations (ACOs). TMA PracticeEdge similarly will provide tools to reduce physicians’ growing data-entry burden to allow them to focus on taking care of their patients. The goal is to establish a system that pays physicians and providers based on the quality of patient outcomes and patient care.
While most ACOs are constrained by a specific hospital system, TMA PracticeEdge will help connect physicians centered on the needs of their specific patients. TMA PracticeEdge will offer participating physicians the means to provide coordinated collaborative care, including prevention and management of chronic disease.

“This represents a significant investment in our relationship with the TMA and Texas physicians, and will benefit our members, who value their relationships with their independent physicians,” said Bert Marshall, President of Blue Cross and Blue Shield of Texas.

ASSOCIATE MEMBER HIGHLIGHTS

TAHP would like to welcome one of our newest associate members: MCNA Dental.

MCNA Dental proudly serves 1.6 million Medicaid and CHIP children across Texas, working in partnership with the Texas Health and Human Services Commission as a managed care Medicaid and CHIP dental benefits administrator since 2012. Its focus on continuous quality improvement is driven by one unifying theme: innovation.

MCNA invests in innovation within its programs and processes to ensure access to high quality care and services for its members and continued growth within its statewide provider network. In 2014, the plan earned the singular distinction of becoming the first dental plan to be awarded full Dental Plan Accreditation from URAC, a leading Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry. The company was also the first dental plan to receive Claims Processing Accreditation from URAC.

MCNA invests in innovation to build enduring, respect-based relationships with dental providers in order to maintain its robust network focused on important preventive dental services. Its NCQA-certified Credentialing Program upholds rigorous standards for quality. MCNA works closely with its network of dentists to provide Main Dental Homes for our members that provide comprehensive care and encourage successful, provider-patient relationships, and emphasize prevention.

MCNA supports its providers with dedicated customer service and innovative technology through its user-friendly Provider Portal that streamlines administrative tasks, allowing for more time to dedicate to the care of patients. Additionally, MCNA supports its providers’ mission to educate children about good oral health through topical videos that are created in-house and available on the company’s website at www.mcna.net along with a wide selection of interactive games and downloadable oral health educational materials.

Legislative Birthdays

03/01 Sen. Eltife
03/01 Sen. Rodriguez
03/03 Rep. Bonnen
03/05 Rep. Munoz
03/05 Sen. Hall
03/07 Rep. Walle
03/07 Sen. Hinojosa
03/08 Rep. Capriglione
03/09 Sen. Perry
03/10 Rep. Faircloth
03/13 Rep. Farias
03/14 Rep. Oliveira
03/15 Rep. Elkins
03/15 Rep. Landgraf
03/18 Sen. Watson
03/19 Rep. Rick Miller
03/23 Rep. Wu
03/24 Rep. Zerwas
03/25 Rep. Larson
03/26 Rep. Villalba
03/29 Rep. Paul