Medicaid Population

Contributing experts: Kurt Small and Adrienne McFadden, MD, JD

Care providers often face challenges treating Medicaid enrollees, who may have chronic, complex conditions and health needs related to social drivers, with relatively fewer resources available to them compared to other patient populations. That's why it's vital to have clear and sustainable care provider incentives and support to help them manage their patients' health.

Our value-based care strategy allows us to tailor arrangements to the needs of our Medicaid population so that everyone — care providers, their patients, and payers — benefits from quality, lower-cost care with a focus on whole health.

Our Medicaid-affiliated health plans serve more than 9.9 million Americans in 26 states, with 61.13% of healthcare spend attributed to care providers in value-based contracts.1

Our contracts encourage care providers to progress along the risk continuum — and our Provider Success unit partners with them along that journey. These relationships support care coordination, while allowing our consumers to receive more preventive care and screenings and providing access to community resources for patient referral. The cost and quality performances of Medicaid and Commercial care providers engaged with Provider Success teams improved more than those not engaged.2

We offer value-based primary care and specialty value-based care arrangements for care providers in our affiliates' Medicaid networks. Those include condition-specific arrangements, including for obstetrics and substance use disorder, or care-site specific, such as programs exclusive to skilled nursing facilities. As in other lines of business, we're seeing evidence that value-based care improves health outcomes.

Internal assessments conducted by our program evaluation team show that care providers participating in value-based care arrangements perform better than their nonparticipating peers.

Personalized, Holistic Care Improves Outcomes

Hear how our whole-health approach has helped one consumer live independently after a brain tumor diagnosis.

Provider Quality Incentive Program

Our Provider Quality Incentive Program (PQIP) is an example of a shared-savings program that recognizes and compensates care providers for quality and cost-effective healthcare to patients covered by a Medicaid plan. PQIP is a value-based program available to medical groups caring for 1,000 or more of our Medicaid consumers.3 Nearly 1.7 million Medicaid consumers are assigned to a care provider participating in PQIP.4

Clinical Quality Performance with Medicaid Value-Based Care5

Participating care providers perform noticeably better than their nonparticipating peers in clinical quality measures, which translates to effective preventive care, resulting in fewer illnesses and complications from chronic disease for their patients.

For example, Medicaid value-based care promotes better management of diabetes so patients can avoid complications like heart disease, kidney failure, blindness, and amputations. It also promotes well-child visits that help ensure children receive recommended immunizations and other preventive care.

  • Child and Adolescent Well-Care Visits: 5.1% higher
  • Diabetes: Eye Exam: 6.4% higher
  • HbA1c Control for Patients with Diabetes: 8.7% higher
  • Weight Assessment and Counseling for Nutrition for Children and Adolescents: 13.1% higher
  • Controlling High Blood Pressure: 15.1% higher

Social Drivers of Health Provider Incentive Program

Because we know how much health is shaped by social factors, our health plan affiliates' Medicaid Social Drivers of Health Provider Incentive Program (SDOHPIP) is built to support care providers who look at health beyond the exam room, helping identify patients' health-related social needs.

SDOHPIP incentivizes care providers to obtain a baseline understanding of social drivers of health needs for our consumers. Our health plan affiliates then connect consumers with community resources through a referral. Those community services can help improve health outcomes, reduce health disparities, lower avoidable emergency room utilization, and reduce overall healthcare costs.

SDOHPIP serves nearly 400 care provider practices, including primary care and specialties, and their patients in 19 states, with plans to expand in 2024.6

Integrated Collaborative Care Model

The Integrated Collaborative Care Model (ICCM) developed by our Louisiana Medicaid affiliated health plan encourages health delivery redesign by incentivizing holistic community care processes and workflow changes necessary for better outcomes, while involving health delivery partners throughout our health affiliates' consumer communities.

ICCM is a value-based program that incentivizes collaboration entailing the biopsychosocial integration of evidence-based practices and care coordination, while mitigating barriers to care, especially for vulnerable populations who may require more frequent and more costly care.

ICCM Clinical Quality Performance

The ICCM offered by our affiliated Medicaid managed care plans in Louisiana saw significant improvements, year over year, since 2018, including:7

Decrease of

17%

in emergency room visits.

Decrease of

8%

in inpatient stays.

Medicaid Redetermination Assistance

In addition to supporting care providers in value-based arrangements, we provided them with resources to help their patients who were at risk of losing coverage due to Medicaid redeterminations with the end of the COVID-19 Public Health Emergency in 2023. Medicaid redeterminations for as many as 15 million enrollees started again, with millions of enrollees needing to complete a renewal application — many for the first time and no longer qualified for coverage.8

As patients turned to care providers for help, Elevance Health and our affiliated health plans provided clinicians with resources to share with them, including:

  • Medicaid renewal and redetermination education via an online hub.
  • Webinars to help care providers plan for and act on behalf of patients.
  • Guidance on how to determine eligibility and coverage dates.

1 Elevance Health, internal reporting (December 2023). 2 Elevance Health, internal reporting (2023). 3 Elevance Health, internal reporting (December 2023). 4 Elevance Health, internal reporting (February 2024). 5 Elevance Health, internal reporting (December 2023). 6 Elevance Health, internal program report (December 2023). 7 Healthy Blue, Integrated Collaborative Care Model (February 23, 2023). 8 Department of Health & Human Services, Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches (August 19, 2022): aspe.hhs.gov/sites/default/files/documents/404a7572048090ec1259d216f3fd617e/aspe-end-mcaid-continuous-coverage_IB.pdf.