By: TAHP | Monday, June 13, 2022

By Jessica Lynch

In Texas, the 1115 Medicaid Transformation Waiver allows the state to expand managed care, which allows for innovations not permitted in traditional fee-for-service Medicaid. Since the inception of managed care, ensuring high-quality care for members has been the work of managed care organizations. Here are some ways Texas managed care health plans go beyond the walls of a doctor’s office to increase community access to services, reduce unnecessary hospitalizations, and improve the quality of members’ lives:

• Texas Children’s Health Plan (TCHP) created two Centers for Children and Women to help address significant access to care issues for its members in its member population. These medical health centers exclusively serve TCHP members and provide comprehensive health care for children and women. The Centers meet the unique needs of TCHP members by bringing together disciplines from obstetrics, pediatrics, behavioral health, nutrition, pharmacy, dental, and more under one roof and in one coordinated care path. This approach minimizes barriers to care like transportation, lost work days, and referrals. The centers are also strategically located in medically underserved communities to provide greater access to care for those who need it most.

• UnitedHealthcare launched an initiative that identifies members who are chronically homeless and assigns a housing case manager to move them to stable housing. Working with the Ending Community Homelessness Coalition in Austin (ECHO) and the Houston Coalition for the Homeless, United’s Health + Housing Program includes engagement in housing needs assessment, assignment of a housing case manager, immediate enrollment with PCP, and a dedicated service coordinator. To date, UHC’s partnership with New Hope Housing in Houston has housed 29 individuals. This program has realized an overall decrease in medical claims of 44% on average, and an overall reduction in behavioral health claims of 50% on average.

• Cook Children’s Health Plan implemented a multimodal approach to improving community access to services, including value-added services, alternative payment models, and targeted outreach, which prompted a significant increase in child and adolescent access to well visits.

• Superior Health Plan’s Integrated Diabetes Program was implemented in 2011 and focused on care management intervention upon discharge for foster care children with multiple diabetic admissions. This intervention reduced the diabetes short-term complications admission rates by 45% and 30-day readmission rates after diabetes-related inpatient stays from 55.7% to 14.1%.