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Verisys Presents at the 11th Annual Medicaid Innovations Forum in Orlando, FL

February 13, 2020

Verisys presented at the 11th Annual Medicaid Innovations Forum held Feb 5-7 in Orlando, FL. This conference offers a unique combination of forward-thinking perspectives, first-hand case studies, and examples of innovation from both Medicaid managed care plans and state government agencies.

Through case study presentations, industry expert sessions, and interactive panel discussions, this groundbreaking program goes beyond policy to explore the specific strategies that leading organizations are leveraging to address within these key areas:

  • Adapting to Medicaid Market Changes
  • Behavioral Health/SUDs
  • Patient Interaction
  • Care Coordination and Care Delivery Innovations
  • Pharmacy Innovations
  • Managing Medicaid Growth
  • Operational Innovations

What is Medicaid and Who Does it Serve?

Medicaid is a federal-state program originally envisioned as a safety net for poor families and severely disabled people. Today, it covers about 1 in 5 Americans, at a total cost of about $600 billion annually. In states that expanded Medicaid under former President Barack Obama’s health law, it’s become the insurer for many low-income working adults.

States design and administer their own Medicaid programs within federal rules. States determine how they will deliver and pay for care for Medicaid beneficiaries. Nearly all states have some form of managed care in place. MCOs accept a set per member per month payment for these services and are at financial risk for the Medicaid services specified in their contracts.

The Medicaid program, overseen by the Centers for Medicare & Medicaid Services (CMS), spends more on medical and health-related services than any other federal program (except Medicare). GAO designated Medicaid as high risk in 2003 because of concerns about federal oversight of this large, growing, and complex program.

Medicaid covered about 75 million people in fiscal year 2018, at an estimated cost of $629 billion—$393 billion of which was paid by the federal government. CMS has projected that Medicaid spending will grow at an average rate of 5.7 percent per year from fiscal years 2017 through 2026. In fact, Medicaid spending is expected to reach $1 trillion by fiscal year 2026.

What are Medicaid Managed Care Plans?

Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. Managed care plans operate with the primary goal of managing two major aspects of health care for their members: cost and quality. With these Medicaid plans, the insurer contracts with certain health care providers and facilities to provide care for their members at a reduced cost. These providers then make up the plan’s network.

Challenges Faced by Medicaid Managed Care Plans

Medicaid beneficiaries have a unique set of challenges that Medicaid managed care plans and payers are faced with. These members are often low-income individuals whose main focus and priorities are finding ways to meet their most basic needs of food, shelter, and stability. They may work multiple jobs or have difficulty finding and keeping a job, have uncertain, unsafe, or temporary living conditions, have difficulty with childcare, not have access to good education, have poor diets and poor exercise habits, and lack the resources they need to improve their socioeconomic status.

Because Medicaid members are often preoccupied with just making ends meet, getting them to engage with their plan providers is an ongoing challenge. One way managed care plans try to engage Medicaid members is through community resources and local charitable organizations in place to assist low-income families. Partnering with these resources in an effort to raise the standard of living for Medicaid recipients is an important step in getting better member engagement.

Understanding the social determinants of health (SDOH) that affect Medicaid recipients provides context to the types of programs payers can partner with to resolve the health care issues these members face. Some of these programs include in-home health care, medical transportation, meal programs, rehab and therapy programs, telehealth, home modification, and social engagement programs. By getting involved and offering assistance to members, plan providers and payers can help to improve the health and wellness of its members.

How Verisys Assists with Medicaid Managed Care Plans and Improved Patient Care

Verisys is a Credentials Verification Organization dedicated to improving the quality of health care in the U.S. by ensuring health care providers and staff are thoroughly licensed and screened which reduces fraud, waste, and abuse in the health care system. Proper credentialing of providers and staff ensures that government funding is not wasted on fraudulent claims and quality providers increases patient care and safety.

Verisys supports Medicaid managed care providers and payers by helping to identify providers who are ineligible to receive payment for Medicaid services rendered. Proactively screening and monitoring providers and staff who serve Medicaid recipients will reduce improper claims and payments thus reducing waste in health care spending.

Juliette Willard Written by Juliette Willard
Healthcare Communications Specialist
Being creative is my passion! Writer. Painter. Problem Solver. Optimist.
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