Medicaid Managed Care Best Practices Compendium 2017-2018

Publication Year: 2017-2018
Patient Need Addressed: Behavioral health, Chronic Conditions, Long-term services and supports, Oral health
Population Focus: Complex care, Vulnerable/disadvantaged
Demographic Group: Adult, Child
Type of Literature: Grey


Insights Results

Overview of article

  • Through the evaluation of submissions of best practices for consideration by health plans, the Institute for Medicaid Innovation established 4 key best practices and associated promising practices. These include: 1) Behavioral health; 2) Long-term care and transitions of care; 3) Children’s health; and 4) Oral health. Within each best practice (i.e.., practices established through implemented programs with resulting data) and promising practices (i.e., practices identified through ongoing programs without resulting data), the review committee has outlined past and current programs within Medicaid managed care

Methods of article

  • A review panel composed of individuals from insurers, research institutions, policy, patient organizations and more


    Behavioral health
  • Common priorities of the programs targeting Behavioral healths include reduction in substance abuse, decrease in homelessness, reduction in cost savings, and reduction utilizations and readmissions
  • For example, the Forensic Assertive Community Treatment (F/ACT) to Reduce Homelessness was established by the Mercy Maricopa Integrated care (Aetna Medicaid). This program aims to reduce recidivism by having sheriff’s office, probation or parole departments utilize a screening assessment to identify those at risk for recidivism. F/ACT teams collaborate closely with treatment providers and probation/parole officers to develop release plans that address the unique social and clinical needs of each individual. For example, the F/ACT team may facilitate peer support services to reduce continued involvement with anti-social peers and help individuals identify and participate in pro-social activities.
    This program has reduced arrests and homelessness and improved behavioral and physical healthcare
    Long-term care and transitions of care
  • Common priorities of the programs targeting long-term care and transitions of care include improvement in post-transition utilization, improvement in patient satisfaction and care management, and financial savings
  • For example, Community Transitions for the MLTSS Populations, developed by UnitedHealthcare Community Plan of Kansas, is an initiative to educate, assess, and support transitions from an institutional setting to the community for those who expressed interest in returning to the community. Although supporting members through community transitions has always been a component to UHC’s MLTSS program offerings, this initiative leveraged new innovative partnerships with Centers for Independent living, built shared tools to facilitate collaboration with partners, and measured the impact on members through implementation of a Quality of Life survey. This innovative and comprehensive approach has supported more than 600 individuals who have moved successfully and safely into the community within the past two years
    Children’s health
  • Common priorities of the programs targeting children’s health include reduction in healthcare costs, better patient and family engagement, and reduction in absentee rates, and improvement in screening rates
  • For example, a Model of Care: Care Coordination of Health-care for Complex Kids (CHECK) was established through a partnership between Meridian Health Plan and the University of Illinois College of Medicine at Chicago’s Coordination of Healthcare for Complex Kids. CHECK is a demonstration funded by CMS to test a model of care for improving the health of children and families affected by asthma, sickle cell disease, diabetes, or prematurity. The goal of the initiative is to improve the
    overall health and quality of life for this population. Community Health Workers help navigate the healthcare system and address social needs, with the goal of improving chronic disease self-management, access to resources, and school attendance rates. A team of licensed professionals use a care model that provides direct interventions to patients and their families. Together, each component of this program model works in collaboration to create a valuable pediatric community and population health model. To date, nearly 13,000 families are enrolled, over 5,000 families are engaged, and 70,000 instances of patient contact have been reported
    Oral health
  • Common priorities of the programs targeting oral health include increasing the number who enrollees who receive an annual dental visit and improved coordination of dental health and primary care
  • For example, UnitedHealthcare Community Plan (UHCCP) Arizona credentialed and contracted with
    Affiliated Practice Dental Hygienists (APDH), an integrated program with primary care clinician teams to improve access and address gaps in care. The purpose of this initiative is to increase the proportion of UHCCP enrolled members ages 2-20 who receive an annual dental visit. Rather than waiting for members to go to dental providers, the health plan brings a dental team member to the member’s medical primary care provider (PCP) office. APDHs can provide basic screening and fluoride to the full range of preventive services. The APDH provides education and when needed, refers members to their affiliated dentist for comprehensive examination and treatment. Through this additional care option in the primary care setting, there is opportunity to identify social determinants of health (SDOH) and to make referrals into the UHC myConnections program (a network designed to help address SDOH).

Key takeaways/implications

  • The programs typically improved patient/family care outcomes (e.g., reduction in homeless members) and clinician outcomes (e.g., increase in clinician visits). The interventions also typically yielded costs savings and had a community impact
  • Common challenges across the identified programs include need for updates to support such programs (e.g., policy changes, updates to technological infrastructure), community buy-in/engagement, issues with time and staffing, and patient access to care
  • Common elements that supported program success include cross-stakeholder/community support, management and coordination, input from the population in focus (e.g., through focus groups, partnership with patient organizations), and flexibility