A Medicaid expert on managed care
Hear from Tom Betlach, the former director of Arizona’s Medicaid program, on why managed care is right for states like Oklahoma.
Medicaid in Oklahoma
Oklahoma’s Medicaid program, SoonerCare, provides healthcare to many individuals facing economic and social barriers to help improve their health and wellbeing.
A state and federal program
Although the federal government provides general regulations for states to follow, states ultimately create a Medicaid program that best serves their citizens. The state of Oklahoma determines who is eligible for the Medicaid program, how the program delivers services, and how the state pays for care.
The federal government pays for at least 50% of the Medicaid program. In 2021, the federal government will pay 74% of all Medicaid costs while Oklahoma will pay the remaining 26% of Medicaid costs.3 How much the federal government contributes is a three-year average of per capita personal income in the state, and the federal match can go up or down depending on the Oklahoma economy.
74%
of all Medicaid costs will be paid by the federal government in 2021, while Oklahoma will pay the remaining 26% of Medicaid costs.3
Higher quality care
Improving population health
The modern managed care model is based on the delivery of quality care that provides services that are medically necessary for people when they need them. MCOs empower members to engage with their own healthcare, providing education around and support for preventive services. This engagement with preventive services is particularly critical in Oklahoma.
See how OK stats compare to national medians.
In Oklahoma, an estimated 43% of drug overdose deaths in 2018 involved opioids.4 MCOs can play a central role in driving positive health outcomes across states, in particular, helping address the opioid epidemic by working with providers around prescribing practices and instituting checks to curb the abuse of opioids among Medicaid enrollees. Modern MCOs also integrate behavioral and physical health considerations to better monitor all aspects of patients’ health.
23%
of deliveries in Oklahoma included timely postpartum care, compared to the national median of 61%5
The right partnership for Oklahoma
SoonerCare can be at its best in partnership with modern MCOs, which can help Oklahoma deliver higher quality healthcare in new ways.
How MCOs are held accountable
Unlike the fee-for-service approach, the modern managed care model is measured against specific quality standards by federal and state governments. Modern MCOs are accredited and regularly reviewed using up to 69 quality measures by the National Committee on Quality Assurance (NCQA) as well as by state agencies.
Performance measures set by states ensure that modern MCOs deliver consistent, high-quality care that is aligned with state strategies to improve population health, while also providing competition and choice for recipients.
Provider experience
Helping states help providers
Through Medicaid managed care, providers benefit as well. MCOs use value-based payment models that incentivize, empower, and reward providers for the quality of care.
MCOs also help maintain strong provider networks and offer clinical support, continuing education, and technological innovations that enable providers, especially rural providers, to deliver higher quality care.
Due to the flexibility of the managed care approach, MCOs can provide relief payments to support providers in times of crisis. During COVID-19, MCOs are providing advanced payments to providers (separate from the Centers for Medicare & Medicaid Services (CMS) payment program) and advocating for additional federal action that can ensure critical support to providers during this pandemic.7
40
states currently partner with MCOs to administer Medicaid.8
Patient experience
Partnerships to address social determinants
By coordinating care, modern managed care organizations can help treat the whole person, serving as the glue that binds community resources with a unified health strategy, integrating physical and mental health services.
Nationally, MCOs’ social determinants initiatives are widespread and address numerous aspects of health, with 77% of MCOs reporting housing activities, 73% report nutrition activities, and 51% report education activities that aid the Medicaid population.9
The managed care model, unlike the fee-for-service approach, is built to bring together disparate parts of the delivery system. Modern MCOs are incentivized to partner with community groups to address social determinants of health, which can have a significant impact on the health of Oklahomans.
73%
of MCOs report nutrition activities 9
Sources
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“Fast Facts Archives,” Oklahoma Health Care Authority, 2022.
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“Fact Sheet: Who Could Medicaid Reach With Expansion in Oklahoma?,” Kaiser Family Foundation, 2019.
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“Oklahoma Opioid Involved Deaths Related Harms,” National Institute on Drug Abuse.
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“Prenatal and Postpartum Care: Postpartum Care,” Medicaid.gov, 2020.
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“10 Things to Know About Medicaid Managed Care,” Kaiser Family Foundation, 2022.