New Study Shows Texas Medicaid Managed Care is Improving Quality & Access to Care

The Medicaid managed care approach in Texas is a national model for savings and improved health outcomes, and a recent major study from the University of Texas School of Public Health shows us just how successful this approach has been.

The new report, prepared for Methodist Healthcare Ministries of South Texas, finds that Medicaid managed care organizations (MCOs) in Texas are achieving access and quality benchmarks that are better than the former fee-for-service model and comparable to those achieved by private health insurance.

Of seven rates studied, four Medicaid MCO rates were better than private health plan rates for each year examined. These included: ensuring more well-child visits for adolescents, reducing the number of C-section deliveries, achieving timely prenatal care visits for expectant mothers, and preventing hospital admissions for children with asthma. In many other areas, MCOs achieved comparable results to private health insurance, making important strides since the State began shifting from the former fee-for-service approach to the managed care model.

More Well-Child Visits for Teens

“Well-child visits” for adolescents are defined as at least one preventive visit per year for youth, ages 12–21. Getting teenagers to the doctor for their preventive well-child visits has always been a challenge. However, preventive visits for teenagers are important because providers evaluate their physical and mental health using developmentally appropriate assessment tools. If there are signs of problems, providers can address through interventions including referrals to specialty providers. Also, these well-child visits are important to make sure teens have their necessary vaccinations. As evidenced by the UT study, only 43 percent of youth enrolled in a commercial PPO received a preventive visit in 2012. Adolescents under Medicaid MCO management fared much better, with 15 percent more teens receiving their important well-child visits.

Timely Prenatal Care

Timeliness of prenatal care is defined as deliveries in which the mother received a prenatal care visit in the first trimester or within 32 days of enrolling in private health insurance or Medicaid. For expectant mothers under Medicaid MCO management, 13 percent more women received timely prenatal care than those enrolled in private health insurance.

Reducing Frequency of C-Sections

Cesarean deliveries lead to more stays in the neonatal intensive care unit (NICU) for infants and increased health care costs, and can pose greater risks than vaginal deliveries. According to the American College of Obstetricians and Gynecologists, there was a 60 percent increase in the number of women in the U.S. who gave birth by c-section from 1996 to 2011. The ACOG says, “Although cesarean birth can be life-saving for the baby and/or the mother, the rapid increase in cesarean birth rates raises significant concern that cesarean delivery is overused without clear evidence of improved maternal or newborn outcomes.”

In Texas, Medicaid MCOs are out-performing private health plans by 4 percent when it comes to reducing the number of c-section deliveries.

Preventing Hospital Admissions for Asthma

In the United States, pediatric asthma continues to be a leading cause of hospital admissions, with readmission rates between 10 percent and 40 percent. While there is no cure for asthma, the disease can be effectively managed and the frequency of attacks can be controlled through continuity of care, appropriate monitors, effective use of the right medications and limiting exposure to triggers. In Texas, Medicaid MCOs kept almost three times the number of children with asthma out of the hospital than private health plans did.

Managed Care is Saving Lives & Dollars in Texas

Since the transition began from the former fee-for-service (FFS) approach to managed care in the Texas Medicaid program, the numbers and outcomes paint a clear picture: flexibility has created a remarkably successful partnership between Texas and the health plans that manage Medicaid. Compared to the FFS model it replaced, the managed care approach will achieve more than $7.1 billion in taxpayer savings by 2018 . Taxpayer dollars are being saved through better care coordination, private market competition and negotiations, and reductions in fraud, waste and abuse. As a result, Texas has some of the lowest per capita Medicaid costs in the country.

Just as important, and as evidenced by this study, Medicaid managed care has dramatically improved the lives, outcomes, and quality of care for Medicaid patients. In addition to the study’s findings, we know that since the shift began from FFS to managed care, hospital admissions across the program are down 20 to 40% for some of the most common and treatable conditions, including diabetes, pneumonia, and infections.

As the 85th Legislature considers proposals related to Texas Medicaid, the Texas Association of Health Plans will be strongly advocating for continued flexibility that allows MCOs to innovate and ensure high quality of services. We will also continue to push for the full integration of Medicaid Benefits, which will result in further improvements in health outcomes and cost-savings.

To read more about the full report from the UT School of Public Health, click here. To read TAHP’s legislative guide to Medicaid managed care, click here.

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