WASHINGTON – Most Medicaid programs are embracing alternative delivery models that include patient-centered medical homes, shared risk, and value-based payment.
That conclusion is based on the results of a survey of the nation’s 51 Medicaid programs conducted for the Kaiser Family Foundation and the National Association of Medicaid Directors.
Not surprisingly, states that decided to expand Medicaid eligibility under the Affordable Care Act had higher enrollment growth and greater overall spending. The federal government is covering 100% of the cost of new Medicaid enrollees through 2016. Enrollment grew 18% in the 28 expansion states (which includes Washington), and spending rose 18%. Just 4% of the spending came out of state coffers. In nonexpansion states, enrollment grew 5%, while spending rose about 7%.
All states are looking for ways to contain costs and improve access and quality, said Vern Smith, who is a consultant with Health Management Associates and was involved in the survey.
In fiscal 2015 (which started in June 2014), 40 states have established some kind of payment or delivery system reform as compared to 30 in FY14, Mr. Smith said at a briefing held by Kaiser. “In some ways, this an even bigger story than the eligibility and enrollment changes.”
The models that states are using to align payment with outcomes and accountability include patient-centered medical homes, Medicaid health homes, and accountable care organizations. States are also increasingly integrating behavioral and physical health programs, Mr. Smith said.
Managed care is the main vehicle for achieving the new payment and delivery models; only three states – Alaska, Wyoming, and Connecticut – do not use managed care for their Medicaid recipients.
Overall, 24 states had a medical home in place in fiscal 2013, 17 were adding or expanding them in FY14, and 20 said they planned to do so in FY15, according to the Kaiser survey. Connecticut has a patient-centered medical home program that includes 1,273 providers and covers 254,000 of its 745,000 Medicaid recipients.
To spur new delivery and payment models, Tennessee launched an initiative in 2013 to focus on value as it pays for Medicaid services, Darin Gordon, director of TennCare, said at the briefing.
The goal over the next 5 years is “to get over 50% of our spend in some type of value-based payment,” he said.
The trend seems likely to stick, the survey authors said. “Whether a state elected to expand or not, Medicaid programs across the nation are being transformed with new enrollment procedures and outreach efforts combined with increased emphasis on delivery system reforms,” said Diane Rowland, executive vice president of the Kaiser Family Foundation.
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