States Increase MCO Demands Around Health Equity, SDOH

by Lauren Flynn Kelly

With procurements picking up after the COVID-19 public health emergency derailed some states' efforts last year plus an increased emphasis on health equity and social determinants of health (SDOH), Medicaid managed care organizations have a lot to manage when it comes to competing for new Medicaid pacts.

During a presentation at the AHIP 2021 National Conference on Medicare, Medicaid & Dual Eligibles, held virtually from Sept. 21-24, two Medicaid managed care experts discussed some of the trends in Medicaid requests for proposals (RFPs) and ways MCOs can respond accordingly.

States aim to address disparities:

• Describing the current RFP environment as both "exciting" and "brutal," Joel Menges, CEO of The Menges Group, observed that the level of detail respondents are being asked to include in their bids has definitely gone up.
• Tom Betlach, partner with Speire Healthcare Strategies, added that his firm is seeing more of a focus on quality and improving care for complex populations, extending beyond traditional medical services with tactics to address SDOH and health disparities. States are looking at ways in which they can capture data and really drill down into where disparities exist and "what managed care can bring to the table from a strategy perspective," he said.

Protests may have negative impact:

• One unfortunate trend that's emerged from increased competition is more protests leading to more re-procurements, he noted, with some states having to bid three times. Those protests can lead to "extensive delays" in the implementation of new programs and may give policymakers pause when it comes to using Medicaid managed care, suggested Betlach.

Other trends:

• Another trend involves strategies to better align the Medicare and Medicaid benefits for dual-eligible individuals, although states are still in the early stages of figuring that out, observed Betlach.
• When it comes to competing on re-procurements, Betlach and Menges both advised that incumbents not rest on their laurels. "States are trying to get their programs north of where they [are today], so in order to do that, you have to go big on what you’ve been doing," said Menges.
• It is also critical that a bidding MCO understand the local market, the issues it faces and the strategies states are interested in pursuing to address those issues, said Betlach.

From RADAR on Medicare Advantage