The RISE Conference held in Chicago on April 29th is an invite only exclusive think tank made up of Medicaid leaders from across the country discussing the evolving Medicaid landscape and sharing their vision on emerging trends in 2019.
The conference kicked off discussing Medicaid issues at the plan, State and National levels. The health plans presenting voiced concern about the 1115 Waiver work requirement which has been adopted by 7 states and soon, many more to follow. The main challenge – helping the plans’ members keep their coverage and work thru the anticipated red tape to do so. Also concerning to the plans who presented were how the providers would know if a member had lost coverage. Finally, major unanswered questions were voiced such as, will ED usage and readmissions increase once coverage is lost.
Mergers are drastically condensing the number of managed care providers and as a result, the smaller plans will be able to become more innovative with programs around SDoH. For example, reducing overall readmits with the homeless population or merging affordable housing w/a health plan
The consistent message at the conference was that in 2019 the growth in Medicaid will be with long term support. This didn’t surprise anyone and nor did the challenges voiced. Unanswered questions such as how to get the community organizations involved? How to set up performance standards? There needs to be better financial alignment and specific data on “scientific interventions” to understand the impact was also discussed. One managed care plan said it best, “it’s all in the art of partnership, find others that can do it better and take a secondary role”.
Behavioral health and physical health were a hot topic and the need to minimize the “islands” of MCO’s that have contracts for BH and MCO’s for physical health. Creating an integrated delivery system is challenging for a number of reasons, i.e. billing is different and so are the confidentiality rules etc.
The consistent message during the two-day conference was on integrated delivery. Whether it’s merging BH with physical health, plans to work with community-based organizations and building technology platforms to support all aspects of SDoH. It all comes down to; who is going to deliver and get paid for it, who is going to build and pay for the technology platform integrate all of it. Simple, right?