Through preventive measures such as primary care visits and health screenings, MCOs are able to identify health issues earlier and ensure beneficiaries have resources to pre-emptively address potential health issues.
In 2017, thousands of Pennsylvanians accessed preventive screenings and checkups through the Medicaid managed care model, including: 153,000 cervical cancer screenings, 104,000 breast cancer screenings, and 68,000 colon cancer screenings1
MCOs are held accountable to deliver on preventive care. States use quality scores, also known as Healthcare Effectiveness Data and Information Set or HEDIS, to track MCO performance against more than 90 quality measures including prevention and screening such as:
MCOs empower members to engage with their own healthcare, providing critical education on and support for preventive services. This helps members find the right care, at the right time, from the right setting.
According to a survey of community-based organizations, preventive care provided by MCOs is one of the most valuable elements of the Medicaid managed care model.
During the height of the COVID-19 pandemic, MCOs partnered with local organizations to make it as easy as possible to access preventive care measures like vaccines, check-ups, testing, and more.
In 2021, Ohio MCOs introduced a series of initiatives to increase vaccine rates including partnering with local health departments, providing gift cards for members, and ensuring transportation was available to and from vaccine sites. This drove a 49% increase in new vaccinations in the first week of August 2021.2
Some MCOs connect pregnant members with Doulas, non-clinical professionals who provide physical, social and informational support to individuals from prenatal care to labor and delivery and postpartum care.
Doula care is one resource that can improve maternal outcomes for Black, Indigenous, and People of Color (BIPOC) and low-income individuals and increase the number of pregnant individuals having safe, healthy deliveries.
A MCO partnered with The National Institutes of Health to test new methods to improve outcomes in New York Medicaid patients with hypertension. The partnership provided medication reminders to members through an app and offers financial rewards to those who reach certain health goals, such as switching to a low-sodium diet or sustaining medication adherence.