Author: Haley Faulkenberry
May 5, 2021
The Oklahoman
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Oklahoma is moving closer toward adopting Medicaid managed care, a public-private partnership that can improve the quality of and access to health care for almost a million Oklahomans.
Medicaid managed care is a well-established and highly successful model that’s already been adopted by 40 U.S. states. These states partner with managed care organizations (MCOs) to administer Medicaid benefits because it’s the only model with the structure, tools and resources needed to address today’s complex health care needs.
Health care is about more than just seeing a doctor when you feel sick — everything from where you live to what you eat can have a significant effect on your long-term health and wellbeing. What’s called the fee-for-service model, the current model for administering Medicaid in Oklahoma, brings a short-term fix to these types of issues.
This model sees each doctor visit and test ordered as a separate event, often measuring a patient’s experience by the number of services rendered. The model wasn’t created to look at health issues holistically and does not have the infrastructure or the right incentives to proactively identify and improve health outcomes at the community level.
The Medicaid managed care model is instead built for health outcomes — focused on the unique needs of individuals and communities. MCOs take the time and resources to invest and address local health care needs.
MCOs can deploy locally based staff who visit every county and community to understand population health, and work with local organizations to identify where certain types of care or social services are needed most. MCOs can provide not only immediate value to patients but they also invest in measures, such as community support services, that can improve health outcomes over the long term.
MCOs also invest in resources for providers. MCOs in Oklahoma will have dedicated provider support staff working alongside providers all across the state. This team will help doctors and hospitals manage the billing and claims processes, provide training and continued education opportunities, and share critical data and insights about the health of their patients. The state would not be able to hire and adequately manage this type of support team on its own.
Administrative costs in Medicaid managed care also support the coordination efforts necessary to make Medicaid work better for everyone in Oklahoma. An effective program to improve health outcomes for the Medicaid population and ensure Oklahoma spends its health dollars wisely, requires a strong administrative function that allows for oversight and investment in key areas.
Managed care organizations bring the technology, innovation and expertise of the private sector and will partner closely with Oklahoma to build the more modern Medicaid program we need. Oklahoma has been ranked in the bottom of health outcomes for far too long. It’s time to deliver a modern health system that is proven and is successfully advancing health outcomes in other states across the nation.
Haley Faulkenberry is the executive director of the Oklahoma Association of Health Plans.