Latest MCO Leader Survey Results 

This quarter we executed our anonymous survey of MCO C-suite leaders. We asked our general questions as well as targeted questions.

General questions

  • Looking back on the last 90 days, what issues have you been focused on the most? Do you think your peers (leaders in other MCOs) have been focused on similar issues?
  • Looking ahead for the next 90 days, what do you think the most pressing issues will be?
  • What advice would you give to your peers about managing vendor partner relationships?

Targeted questions

  • How important are MCO/PBM issues for your plan? Have recent CMS clarifications on PBM spread pricing and MLR impacted your operations or reporting?
  • How do you think the Public Charge Rule (if enacted) will impact your plan? Have you conducted any internal impact analyses on this regulation?
  • How do you think the new CMS Interoperability rule will impact your operations?

Results are summarized below.

Top issues last 90 days/next 90 days

Most respondents reported a focus on implementing programs to impact Social Determinants of Health. Some respondents were focused on staffing / workforce challenges. Improving analytic capabilities remained top of mind for all respondents.

Advice to peers about managing vendor partner relationships

Tips collected from this survey group included involving leaders and staff from the beginning, validate vendor claims with references, evidence and pilots, making sure to take a broad view of IT bandwidth (i.e. they are involved in a lot more projects than any one person sees) and looking for cross-vendor collaboration.

MCO/PBM issues

Respondents reported that PBM audits and reporting of spread pricing (amounts beyond payments to pharmacies) were good practice, but in general they see states and MCOs moving away from the current PBM model. The impact on MLR reporting was a strong concern. Other respondents emphasized the importance of tight coordination of plan/PBM efforts.

Impact of the Public Charge Rule

Some respondents have already seen a decrease in membership that they attribute to the rule. Other respondents reported that they have conducted analysis on the long term impact on enrollment should the rule go forward. All respondents anticipate an impact to membership, but some also see impacts to service delivery (because some HCBS direct care workers are non-citizen immigrants). Others noted an expected increase in churn due to the rule. One respondent expressed concern that immigrants who remain in the US would then use ED services more, and a related increase in opioid prescriptions would occur.

Impact of the CMS Interoperability Rule

All respondents noted the new possibilities from a health plan care coordination perspective (many new types of data could be introduced into the case management system). Other respondents expressed concern over the lift for their IT departments for compliance with the new rule.