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.

At $15.3 billion annually, Texans spend more on prescription drugs than any other state in the country. Big Pharma continues to raise prices, making lots of prescription drugs unaffordable. During the COVID pandemic alone, Big Pharma raised prices on 832 drugs. Patients are taking to Twitter to express outrage and shock at the rising price of the sometimes life-saving medicine they need.

Today it was announced that since the No Surprises Act went into effect at the beginning of the year, Americans haveavoided more than 2 million surprise bills. The law protects patients from most surprise medical bills and removes them from the middle of negotiations between providers and insurers when it comes to disputes on what should be paid. That’s the good news.

The use of emergency rooms for primary care services is decreasing, thanks to Medicaid managed care. A recent report by the Texas Health and Human Services Commission (HHSC) shows a 15.5% decrease in the number of potentially preventable emergency room visits in Texas Medicaid and CHIP programs. This is great news for both Medicaid members and taxpayers. Utilizing preventative and standard care before conditions become emergencies leads to better health outcomes and to less costly care.

Can driving just a few miles save a patient thousands of dollars? If they’re in the market for health care, the answer is yes. In Dallas, according to a recent article in D Magazine, the cost of a gallbladder removal surgery can range from $5,000 to $35,000. And rarely are prices posted online—even though they’re supposed to be.

Did you know National Nurses Week is now Nurses Month? Extended in 2020 to recognize the extraordinary efforts of nurses during the early days of the pandemic, the American Nurses Association adopted the evergreen theme “Nurses Make a Difference.” At TAHP, we want to acknowledge the positive impact Medicaid managed care nurses have on the lives of their patients.

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