The Anthem Public Policy Institute’s First White Paper Highlights
Innovative Strategies to Enhance Access to Quality Care for Millions of
Americans
WASHINGTON--(BUSINESS WIRE)--Sep. 14, 2015--
As states increasingly look to risk-based managed care to serve the
nearly 70 million Medicaid beneficiaries across the county, traditional
measures of network adequacy do not take into account the many ways
Medicaid Managed Care Organizations (MCOs) enhance network access
through a variety of innovative strategies that promote quality and
value instead of volume, according to a white
paper developed by Anthem’s Public Policy Institute.
Today’s Medicaid networks that serve low-income children, families and
adults, disabled individuals, and long-term care beneficiaries must
address core barriers that have historically impeded access to care
under Medicaid fee-for-service programs. Medicaid MCOs, working with
their provider and state partners, can enhance network access for their
members through strategies that minimize access barriers, embrace new
technologies, and create incentives for providers to deliver
cost-effective, patient-centered care. Anthem highlights several
innovative strategies, including:
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New ways of working with and paying providers to create incentives to
promote team-based, population-focused care,
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Support for non-traditional providers, physician extenders, and
patient access models, such as group visits or plan-operated health
centers,
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Ensuring members get maximum value from providers empowered to work at
the top of their license and training, and
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The use of technology to leverage provider access and expertise and
improve convenience for members.
“Traditional measures of network adequacy – including
physician-to-enrollee ratios and time/distance requirements – are
important, but they paint an incomplete picture of how Medicaid managed
care plans, working with their provider and state partners, enhance
network access and delivery of high-quality care for their members,”
said Jennifer Kowalski, vice president of the Anthem Public Policy
Institute. “We have found many examples across the country of MCOs
implementing quality-focused strategies that improve access for the
nation’s most vulnerable populations.”
Technology is one area that holds promise for enhancing network access
for Medicaid beneficiaries. Tele-health can address geographic,
transportation, and provider shortage issues. For example, almost half
of the counties in Georgia do not have psychiatrists, resulting in many
Medicaid patients being forced to travel long distances for care or
completely forgo the care they need. Understanding the gap in access for
many Georgians, Anthem’s affiliated Medicaid health plan collaborated
with the Georgia Partnership for Tele-Health (GPT) to expand access to
behavioral health through appointments at one of GPT’s “presentation
sites,” often within 30 miles of a member’s home. The response from
members has been positive, with the number of members receiving
behavioral health services through tele-health growing more than
twelvefold from 2011 – 2014.
Care delivery and payment innovations supported by MCOs are also
contributing to increased access to high-quality care for Medicaid
members. For instance, new service delivery models, such as Accountable
Care Organizations (ACOs) and Patient Centered Medical Homes, provide
integrated, population-focused services for members, and align with the
goals of quality of care rather than quantity of care. Medicaid MCOs are
increasingly taking an active role in supporting these practice
transformations, especially for smaller practices that may lack the
resources to achieve transformation on their own. Furthermore, many
providers request value-based payment options in their contracts as a
means to align reimbursement incentives with quality improvement
activities, making value-based payment an important tool that MCOs bring
to network development. Currently, 63 percent of Medicaid members in
Anthem’s affiliated health plans receive services under a provider
incentive payment model.
These are just two of the many examples of MCOs’ efforts to enhance
access to high-quality care for millions of Medicaid beneficiaries. “We
believe these innovative strategies being adopted by MCOs should be part
of the dialogue with state and federal policymakers,” said Kowalski.
“While current network adequacy standards are necessary and provide a
common framework for measuring network supply across plans and states,
the examples in this paper illustrate an opportunity to broaden the
dialog around network adequacy, especially with the delivery system
rapidly moving from volume-to-value-based care.”
A copy of the Anthem Public Policy Institute’s white
paper can be found on http://www.antheminc.com.
About the Anthem Public Policy Institute
The Anthem Public Policy Institute was established to share data and
insights to inform public policy and shape the health care programs of
the future. The Public Policy Institute strives to be an objective and
credible contributor to health care innovation and transformation
through publication of policy-relevant data analysis, timely research,
and insights from Anthem’s innovative programs.
About Anthem, Inc.
Anthem is working to transform health care with trusted and caring
solutions. Our health plan companies deliver quality products and
services that give their members access to the care they need. With
nearly 70 million people served by its affiliated companies, including
more than 38 million enrolled in its family of health plans, Anthem is
one of the nation’s leading health benefits companies. For more
information about Anthem’s family of companies, please visit www.antheminc.com/companies

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Source: Anthem, Inc.
Anthem, Inc. Media Contact: Cindy Wakefield,
404-788-8957 cindy.wakefield@anthem.com
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