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Innovation is Key to Medicaid Network Access

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:

  • New ways of working with and paying providers to create incentives to promote team-based, population-focused care,
  • Support for non-traditional providers, physician extenders, and patient access models, such as group visits or plan-operated health centers,
  • Ensuring members get maximum value from providers empowered to work at the top of their license and training, and
  • 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

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

Source: Anthem, Inc.

Anthem, Inc.
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Cindy Wakefield, 404-788-8957