Texas Medicaid Managed Care

A Fiscally Responsible Pathway to a Healthier Texas

Texas is a national leader in the use of managed care to increase access to care, manage costs, and improve health care quality in its Medicaid program. The managed care private-market approach drives innovation through flexibility and competition, reduces health care costs, and holds Medicaid health plans accountable for providing access to quality care.

The managed care approach, which replaced the former and less efficient fee-for-service (FFS) model in Texas Medicaid, has saved the state $4 billion over a six-year period. Over the next three years, it is expected to save an additional $3.3 billion. For the STAR program— Texas Medicaid’s largest managed care program, with 2.7 million consumers—costs grew only 2.2 percent from 2009 to 2013, while national health care costs grew nearly seven times as much over the same period of time.

Just as important, lives are being saved and improved due to integrated and coordinated care under managed care. Hospital admissions are down anywhere from 20 to nearly 40 percent for some of the most common—and preventable—conditions: asthma, diabetes, GI infections and more. Child “well visits” and childhood immunizations in Texas are surpassing national standards. Beneficiaries are also feeling more confident about the quality of their coverage and access to care. More than 80 percent of Texas families with children in managed care report an overall positive experience with their health plan and more than 90 percent report having access to their primary care provider.

Texas has saved dollars and lives through Medicaid managed care, and it has done so independently and innovatively—making the most of the managed care model. With greater flexibility, Texas can continue to achieve significant savings for taxpayers and healthier outcomes for the millions of Texans who depend on this critical program.

Quotes:

“Over the past 20 years managed care has revolutionized the delivery of Medicaid health care services in Texas.” – Sellers Dorsey, Medicaid Managed Care in Texas, February 2015

“Texas has been very innovative in our policies to ensure Medicaid services are provided in a cost-effective manner through managed care.” – Governor Greg Abbott, September 29, 2015 letter to the federal Centers for Medicare and Medicaid Services

Medicaid Managed Care Resources:

Texas Medicaid Managed Care: Saving Dollars, Saving Lives

A fact sheet highlighting the success and outcomes of Medicaid managed care in Texas.

January 2017

Texas is a national leader in the use of managed care. Medicaid managed care has dramatically improved the lives, outcomes, and quality of care for Medicaid patients. Hospital admissions are down 20 to 40% for some of the most common and treatable conditions, including asthma, diabetes, pneumonia, and infections. A new study has also found that access and quality for Medicaid health plan enrollees is better than Medicaid fee for service and comparable to private health coverage.

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Medicaid Managed Care: A Fiscally Responsible Pathway to a Healthier Texas

A resource guide on how Medicaid managed care operates in Texas.

October 2015

Texas is a national leader in the use of managed care to increase access to care, manage costs, and improve health care quality in its Medicaid program. The managed care private market approach drives innovation through flexibility and competition, reduces health care costs and holds managed care organizations (MCOs) accountable for providing access to quality care.

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Medicaid Managed Care Innovations

A factsheet highlighting some of the innovative strategies used by Texas Medicaid health plans to improve quality, access, and outcomes for Medicaid enrollees.

October 2015

Managed care allows for flexibility in developing new models of service delivery that are not permitted in fee-for-service Medicaid. Texas Medicaid MCOs have implemented innovations to improve community access to services, reduce unnecessary hospitalizations, improve the quality of members’ lives, and pay providers for improved performance.

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What Does it Mean to Managed Care? A Primer on Medicaid MCOs

Presentation on the outcomes and operations of the Texas Medicaid managed care program.

October 2015

This presentation outlines the success that Medicaid MCOs have experienced in Texas, including significant reductions in hospital admissions for asthma, diabetes, GI infections, UTIs, and bacterial pneumonia; better prescription drug management and adherence than FFS; and a 7.9% reduction in total Texas Medicaid costs,  just to name a few.

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Map of the Texas Medicaid Managed Care Service Regions

October 2015

The state of Texas is broken down geographically based on the Medicaid Managed Care health plans providing service in the various regions.

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Medicaid Managed Care: Ensuring Access to Quality Care

A resource guide on how Texas Medicaid health plans ensure their enrollees have access to the right care, at the right time, in the right place; and how the Health and Human Services Commission (HHSC) monitors network adequacy.

December 2015

Access to care is an essential part of any health care delivery system, and the Texas Medicaid program is no exception. Ensuring that Medicaid consumers have access to the right kind of care for their needs at the right time leads to improved health outcomes for Medicaid patients and lower costs for Texas taxpayers.

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TAHP Testimony to House Human Services Committee

Presentation on the outcomes and operations of Texas Medicaid managed care.

March 2016

This presentation shows the value of Medicaid Managed Care in Texas versus FFS, to better manage care to improve access, quality, and outcomes while ensuring appropriate utilization, containing costs, and reducing fraud and abuse.

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TAHP Testimony to House Appropriations Subcommittee on Art. II

Presentation on the outcomes and operations of Texas Medicaid managed care.

April 2016

This presentation shows the Medicaid Managed Care cost savings versus FFS for medical and dental services, and includes recommendations for more cost savings, such as full Rx carve-in and a pharmacy lock-in program.

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TAHP Testimony to Senate Health and Human Services Committee

Presentation on Texas Medicaid managed care efforts to reduce fraud, waste, and abuse.

September 2016

This presentation shows how Medicaid MCOs are transforming their efforts to focus on prevention, reducing inappropriate payment, and finding real-time results and methods to transition from a pay and chase environment.

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Medicaid Managed Care in Texas: A Review of Access to Services, Quality of Care, and Cost Effectiveness

Study prepared by national research firm Sellers Dorsey evaluating access to care, quality of care, and the cost-effectiveness of the Texas Medicaid managed care program.

February 2015

Over the years numerous studies and evaluations have concluded that the Texas Medicaid managed care program was indeed meeting its promise to improve access, reduce cost, and improve quality of care. Expanding Medicaid managed care has been a key Texas strategy for reforming its Medicaid program. Over the last 20 years the population in Medicaid managed care has increased from 58,000 members to over 3 million members.

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Texas Medicaid Managed Care Cost Impact Study

Study prepared by national research firm Milliman evaluating the cost impact of the managed care model on the Texas Medicaid program.

February 2015

This study reveals that from SFY2010 to SFY2015 costs under the Medicaid Managed Care program are significantly less as compared to estimated expenditures on a fee-for-service structure. Savings of nearly $3.8 billion, or 7.9% have been realized during this six year period.

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Managed Care is the Prescription for a Healthier Medicaid Future

TAHP’s Complete Coverage issue on the successes of Medicaid managed care in Texas.

October 2015

Since Texas began embracing the managed care approach, the numbers and outcomes paint a clear picture: flexibility has created a remarkably successful partnership between Texas and the health plans that manage Medicaid.

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Benefits of Prescription Drug Management Under Medicaid MCOs

A resource guide on how Texas Medicaid health plans have achieved savings and better outcomes by managing the Medicaid pharmacy benefit.

April 2015

In March 2012, prescription drugs were carved into Texas Medicaid managed care contracts. The decision was made by the 82nd Legislature not only for the cost-savings, but also the need to improve access to care and quality. Since that time, Texas managed care organizations (MCOs) have made impressive strides in managing the Medicaid pharmacy benefit—saving millions in taxpayer dollars while improving the overall health of their clients.

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