Latest MCO CEO Survey Results

For every issue of the Medicaid Black Book, we poll Medicaid C-Suite leaders about their current concerns and challenges. Here are the things top of mind for many of them (not ranked in order of importance / concern):

  • Social Determinants of Health (SDOH)- Respondents report there are lot of ideas, but few solutions. While there has been some traction in gathering SDOH data via assessments, there still are not a lot of major breakthroughs in connecting the funding streams. Some respondents report early results of MCO-funded housing efforts as well as promising paths tied to tax credit purchases from affordable housing units.
  • Contracting/partnering with community organizations- Most repondents report a trend in procurements using small / diverse business spend as competitive driver in last 18 months. Challenge remains managing smaller providers across an array of service categories in a local market. Also some concern that the directional trends will begin to send too much of cap out of plan to retain stable MLR management.
  • Contracting process challenges- state protest cycles remain a concern, but some improvements in recent procurements to not delay implementation while hearings / cases continue are promising.
  • Rate cert process – Most respondents report general wait-and-see approach to Mega-Reg rewrite around moving back to cert at range level vs individual cells. There has been a significant increase in administrative burden for documentation efforts, but many report it was not as bad as first expected.
  • Next stage in value based care- General concern over the next stage in Medicaid value based care was reported. Most plans have absorbed the capitation withhold models as part of normal financial ops, but the uncertain status of the CMS required “STARS-like” quality rating system for the Medicaid market creates some concern. Slow down of DSRIP waivers that drove major value-based care efforts also leaves many MCO leaders wondering what the major financial vehicles will be to transition to the next stage. Most respondents still rate Medicaid ACOs as a largely unproven path to actual savings for managing Medicaid populations. There are mixed reviews of how burdensome QM can be with state partners (differing by state markets).
  • The progress in integrating behavioral health into Medicaid managed care models remains slow- Most respondents report little success in transitioning BH providers to value-based care models (although states continue to expect MCOs to lead the way on true integration). Most common concern is a lack of fit for metrics for BH compared to the extensive metrics used to measure provider quality in physical health. Respondents also report a general unwillingness of BH providers to move away from legacy payment models, which causes significant disruption during implementation. Respondents predict continued carve-outs for most of BH.
  • Resource drain of managing tech vendor sales processes- Continued massive private investment in health IT has created significant resource drain for most MCOs. Some respondents report staff time losses in the thousands of hours per year dealing with vendor sales pitch meetings and related follow up. One MCO has implemented an entire internal policy to more effectively manage the process.
  • Impact of recent consolidations / mergers with PBMS- Respondents in plans that participated in latest consolidation round (driven by plan / PBM mergers) think the transition will be stable on the ops side but could be rocky on the community relations / government relations side. Concerns largely driven by high-profile issues with spread-pricing and upcoming changes to major regulatory authorities including 340B.  Some respondents report optimism around care management / utilization management made possible with the mergers (i.e., med recc).
  • Work requirements from operational standpoint- While limited in current applicability, most respondents are watching work requirements waiver approvals and considering what changes will need to be made to existing operational protocols. The concern is not ranked as significant at this time.
  • Slow return on IT investments – Most respondents report frustrating with Data- showing impact / value of latest IT investments- Missing credit in data stream (ie services happening but not showing up in data)
  • Growth strategy for smaller MCOs
  • Provider education, esp around new reqs on directories / network adequacy
  • Managing transportation spend