Medicaid Managed Care Survey Highlights Barriers to VBC Adoption
In an annual survey of Medicaid managed care plans, data sharing challenges and provider readiness or willingness to participate in alternative payment models continue to be significant barriers,
The Institute for Medicaid Innovation’s (IMI) annual Medicaid managed care survey is an effort to collect robust, longitudinal data on Medicaid managed care organizations (MCOs) across the following categories: high-risk care coordination, alternative payment models, pharmacy, behavioral health, maternal and perinatal health, sexual and reproductive health, child and adolescent health, long-term services and supports, social determinants of health, health equity, and telehealth.
The findings from the survey are intended to equip Medicaid stakeholders with the information needed to accurately articulate the national narrative about Medicaid managed care.
During a Nov. 15 webinar, Jennifer Moore, Ph.D., R.N., IMI’s executive director, noted that nearly all Medicaid health plans participate in value-based initiatives. “There's still a long way to go to transition from fee for service to value-based care,” she said. “Provider readiness or willingness to participate in the model continues to be a significant barrier, a barrier that we've seen over the past eight years. In this survey, nearly all health plans reported that staff capacity at provider offices is limited, further impairing adoption of value-based payment models.”
Over half of health plans surveyed noted that data sharing is a critical barrier to effective adoption on these models. Of the operational barriers cited by health plans, the top barriers were all related to data, including 55% of health plans noting that data sharing and readiness are not always in place, and 55% information technology system preparedness is a persistent barrier, Moore said.
“It is clear that health plans are invested in value-based payment models, but they still express concern and uncertainty about its impact on quality of care and patient outcomes,” Moore said. “For example, as we've noted for years, in over half of health plans’ value-based payment arrangements, providers are not willing to accept downside risk. This raises doubts about whether value-based payment models will achieve the promised benefits of these models. The percentage of health plans reporting that providers participate in downside risk arrangements has remained below 50% and is not expected to increase. However, it's truly inspiring to see the breadth of efforts health plans are making to implement value-based payment arrangements, including 68% of health plans using strategies to encourage access to care, and 50% providing enhanced payment rates for hard-to-recruit provider types.”
Moore said her organization consistently hears from all Medicaid stakeholders, whether it is a community-based organization or Medicaid health plans, that there are challenges with accessing data, making it difficult to identify disparities and advance health equity. “For instance, half of all health plans reported insufficient data to effectively address disparities. Another 41% indicated that the data they have is incomplete or inconsistent, and almost 20% do not know what data are available. Without reliable data, health plans cannot identify gaps in care, allocate resources appropriately and assess the true impact of health equity initiatives.”
The IMI survey finds that Medicaid health plans are making strides in improving health equity within their organizations, including establishing staff training requirements at 96% and improving their data analytic capabilities at 86%. “These are important steps toward building an equitable infrastructure,” Moore said. “We continue to seek growth in covered services during pregnancy, for example, nutritional counseling. In 2021, 62% of health plans offered this service, and in 2024 that rate increased to 91 percent. Support from community health workers in 2021 was 52%, and today it's 86%.”
On the topic of behavioral health, health plans identified a number of ways that state Medicaid agencies could assist in addressing the behavioral health needs of their members. Highest on the list was facilitating an increase in providers who participate in the Medicaid program and supporting behavioral health providers in home- and community-based services.
All health plans reported that the shortage of in-person available behavioral health providers is a crucial issue, particularly for children and adolescents. In the survey, 87% of health plans said that their members’ ability to access in-person behavioral health is a challenge, and 87% also indicated that excessive wait times for specialty care has been a barrier.
Hemi Tewarson, J.D., M.P.H., executive director of the National Academy for State Health Policy, participated in a reaction panel to the survey’s findings. "On the value-based care piece, I have to say the one thing that shouldn't have surprised me, but that did was that 100% said provider readiness and willingness was a barrier, and that is unchanged from 2017,” she said. “It is little bit discouraging, honestly, to see that health plans have similar challenges with figuring out how to help providers move forward on this. How do we think about making things easier for the providers, as we also struggle with workforce at the same time?”
