Clients: Managed Care
Bailit Health has assisted over 150 clients since 1997 to improve methods for purchasing or regulating health and human services. A partial listing of these clients can be found below, as well as examples of the types of work that we have conducted for them.
California Department of Health Care Services (DHCS)
State Health & Value Strategies (SHVS), a grantee of the Robert Wood Johnson Foundation
New Jersey Department of Human Services
Client
Medicaid and CHIP Payment and Access Commission (MACPAC)
Challenge
As the independent source of information on Medicaid and CHIP, MACPAC seeks a broad range of policy research and analysis to ensure program oversight and accountability. One policy area of focus is Medicaid managed care, the primary Medicaid health care delivery system in more than half of states. With more than 85 million individuals enrolled in Medicaid and CHIP and about 85 percent of these enrollees in some form of managed care, federal and state Medicaid spending on managed care continues to grow each year. In addition, Medicaid managed care provides an opportunity for greater accountability for outcomes and can better support systematic efforts to measure, report, and monitor performance, access, and quality.
Response
Bailit Health conducted three recent studies for MACPAC: “Examining the Role of External Quality Review (EQR) in Managed Care Oversight & Accountability” (2022-2023), “Managed Care Procurement Policy Review” (2021-2022), and “State Strategies to Promote Value-Based Payment Through Medicaid Managed Care” (2019-2020).
For each of these studies, Bailit Health developed selection criteria to identify states for inclusion in the study, reviewed and summarized federal rules and policies relevant to the study, reviewed public documents to understand and inform a landscape review of states selected for the study, interviewed stakeholders in the study states, along with national experts, to obtain their perspectives on key issues.
Bailit Health synthesized the key findings of each study into a final report. Study findings were used to inform MACPAC´s policy considerations and identified opportunities to improve federal mechanisms that advance access, quality, efficiency, and value. In addition, for both the Managed Care Procurement Policy Review and the EQR Study, Bailit Health conducted a comprehensive scan of state activity to provide MACPAC with a clear understanding of differences in approaches across Medicaid programs.
Client
California Department of Health Care Services (DHCS)
Challenge
The California Medicaid agency has two large contracts with different External Quality Review Organizations (EQROs) overseeing different types of Medi-Cal managed care delivery systems. This arrangement is challenging given multiple changes in DHCS Medi-Cal approaches and new federal External Quality Review requirements. DHCS had a short window to assess potential EQRO vendors and develop a consolidated EQRO scope of work aligned across Medi-Cal managed care delivery systems.
Response
Bailit Health conducted market research for DHCS on EQRO vendors that could provide managed physical health, behavioral health and dental services, taking into consideration the size and scope of Medi-Cal managed care delivery systems. We also arranged and facilitated a series of interviews with other State Medicaid staff regarding their EQRO contracts, scope, vendors, and oversight processes. Based on best practices as well as DHCS objectives and priorities, Bailit Health helped DHCS identify an EQRO and create a consolidated, aligned EQRO Scope of Work. We also provided DHCS staff with training on EQRO requirements and contract management strategies to achieve improvements envisioned under a consolidated EQRO contract.
Client
State Health & Value Strategies (SHVS), a grantee of the Robert Wood Johnson Foundation
Challenge
SHVS recognized that implementing a statewide, competitive procurement for Medicaid managed care is one of the more important things state purchasers do to improve value. Medicaid managed care contracts have evolved over time to cover more enrollees and services, often making them the largest contracts awarded by states. However, the size, scope, and intensity of Medicaid managed care procurements can pose significant resource challenges for Medicaid agencies. In addition, because these large, multi-year procurements occur only once or twice a decade, Medicaid leaders and state staff responsible for the procurement sometimes turnover and those now responsible may not have experience with a procurement of this nature or size.
Response
Bailit Health developed a toolkit to assist states with procuring Medicaid managed care entities to offer covered services to their enrollees, and to maximize the benefit of these organizations. This toolkit is designed to help states develop a procurement process focused on improving program performance in specific areas valued by the state. It guides Medicaid agencies through key action steps and considerations in the major phases of the procurement cycle: 1) strategic procurement planning, 2) solicitation development, 3) bid review and selection, 4) contract execution, readiness review and implementation, and 5) contract management. To develop and maintain this toolkit, Bailit Health team members leveraged experience gained from working in state Medicaid agencies and helping states plan for, develop, and implement Medicaid managed care procurements and contracts.
Challenge:
With most states utilizing Medicaid managed care to serve their members, there is a continuous flow of difficult policy and operational considerations and issues for state staff overseeing these managed care plans.
Response:
Since 2018, Bailit Health has developed and facilitated a bi-monthly Medicaid and Managed Care Contracting and Oversight Workgroup meeting for state Medicaid managed care officials which features an open forum for discussion and learning across states on important topics including health equity, health related social needs, managed care procurements and oversight, value-based payment, behavioral health integration, transitions of care, among others. On a regular basis, 15-20 states participate in these meetings. Bailit Health typically provides an overview of the topic, shares expertise, and facilitates state discussion.
Client
New Jersey Department of Human Services
Challenge
New Jersey (NJ) wanted to update its Medicaid managed care organization (MCO) contracts to advance health equity and to review its entire contract with an equity lens. NJ did not have the resources to do a comprehensive review of the existing MCO contract or to create detailed amendments to hold MCOs more accountable for providing culturally and linguistically appropriate services, reducing disparities and improving health equity.
Response
With support from State Health & Value Strategies, Bailit Health developed a series of amendments with a health equity lens for NJ´s MCO contract including provisions related to:
- new and modified definitions,
- collection and use of demographic data,
- health promotion and education activities including roles and composition of key member and provider committees,
- Quality Assessment and Performance Improvement initiatives and evaluations with an overarching equity focus
- meeting members cultural and linguistic needs, including through access to qualified interpreters at the point of care, and reporting on those needs, and
- MCO staffing and the role of the designated health equity officer.
