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To improve the health of vulnerable populations through the support of Medicaid-focused community affiliated health plans committed to these populations and the providers who serve them.

ACAP and the Commonwealth Fund

Release Working Paper on Specialist Contracting Among Medicaid Plans

ACAP and the Commonwealth Fund have released a report called “ACAP Best Practices in Specialty Provider Recruitment and Retention.” A health plan's most valuable resource is its provider network, but many organizations struggle in building and maintaining provider relations and, more specifically, in recruiting and retaining providers. This is particularly true in Medicaid managed care, where historically low reimbursement rates have made recruiting a challenge, particularly for specialty providers. To identify barriers and solutions, ACAP conducted a study of its member plans in the spring of 2004, selecting four plans for in-depth case studies. The plans stressed the importance of two complementary approaches: sustaining relationships with providers through regular and meaningful communications and introducing technology applications to facilitate process improvement. Specifically, ACAP plan leaders experienced the greatest success in improving provider relations in the following five areas: 1) payment practices, incentives, and financial assistance; 2) utilization management; 3) communications and provider outreach; 4) practices to simplify administrative burdens; and 5) enabling services.

ACAP and NASHP Release Survey on Medicaid Managed Care

A major new report from the National Academy for State Health Policy—Medicaid Managed Care: Looking Forward, Looking Back—tracks changes and trends in Medicaid managed care between 1990 and 2002. This report was sponsored by the Association for Community Affiliated Plans. The report can be accessed on NASHP's website.

The report is based on six NASHP surveys of state Medicaid managed care programs (conducted in 1990, 1994, 1996, 1998, 2000, and 2002). The surveys gathered information on the scope and operation of both risk and primary care case management programs. The report also looks ahead and includes a discussion with state officials of trends that may continue and factors that may impact the future of Medicaid managed care.

Among the report’s key findings:

Managed care has grown to be the dominant delivery system in Medicaid, and in 2002 all but three state Medicaid agencies operated a managed care program.
Also in 2002, fully 58 percent of Medicaid beneficiaries received all or some services from a managed care provider.
Since 1990, State Medicaid agencies have expanded managed care to cover more complex populations, implemented payment methods that better reflect the health status of enrollees, and implemented performance monitoring that enables agencies to better assess plan performance.
The past 15 years have witnessed market consolidation (particularly the withdrawal of plans with smaller Medicaid enrollments) and the increasing use of managed care organizations that serve a primarily public population (Medicaid and SCHIP).

For additional information:

Reduction in Neonatal Intensive Care Unit Admission Rates in a Medicaid Managed Care Program. The American Journal of Managed Care.