Medicaid MCOs Deploy Resource Centers to Better Serve Members

by Lauren Flynn Kelly

From engaging members in cooking and self-defense classes to coaching them on specific health conditions, Medicaid managed care organizations are building out brick-and-mortar centers to better serve their enrollees. Three such MCOs shared their experiences at the 11th Annual Medicaid Innovations Forum, hosted by Strategic Solutions Network in Orlando from Feb. 5 to 7.

In an unusual case of competitors joining forces, Blue Shield of California Promise Health Plan and L.A. Care Health Plan said they are building out 14 co-branded "Community Resource Centers" that will serve a projected 1 million individuals in the Los Angeles area annually.

The first joint site opened in December 2019 in Pomona, Calif. The next resource center is due to open at the end of April. The partners will jointly open seven new resource centers, remodel four existing centers and relocate three others to larger locations.

"One of the big shifts for us is to move from more generic programming that is attractive to anyone who walks in the door to programming that will continue to serve the non-member community but also integrating a lot more programming is that is member-specific," such as case management for diabetes prevention, said Francisco Oaxaca, senior director of communications and community relations of L.A. Care.

In the case of Trusted Health Plan, Inc., which was recently acquired by CareFirst BlueCross BlueShield, the Washington, D.C. MCO's center model is focused on health and wellness for low-risk populations.

Using a data-driven approach to stratify members into five groups and properly manage its population, Trusted assigns members identified as "in crisis" to complex case management, those who are seen as "struggling" to case management and those it views as "at risk" to disease management, according to Trusted President and CEO George Aloth.

Those who are identified as stable or healthy generally do not require ongoing support but may need one-time assistance or intermittent assistance and referrals. The health plan recommends these individuals enroll in the "Wellness Navigation Program," which features an assigned staff member and offerings such as health risk assessments, member services and health education that they can access through one of two wellness centers.

From RADAR on Medicare Advantage