June 28, 2023

Kansas can leverage Medicaid managed care to improve health and advance health equity

This opinion piece by Health Fund President David Jordan originally appeared in the Kansas Reflector on June 28, 2023.

Over the next 18 months, the state of Kansas will have an opportunity to improve the health of Kansans.

Taking advantage of this opportunity will not require passing legislation. Instead, it will require the state embracing an innovative approach to the contracting process for the state’s Medicaid managed care program, KanCare.

The state’s KanCare program provides health coverage to approximately 400,000 Kansans, including children, low-income parents and Kansans with disabilities. The KanCare program is managed by private insurers, known as managed care organizations, that contract with the state to deliver high-quality health benefits to enrollees.

As the state begins the contracting process for KanCare, the state has an opportunity to improve the health and experience of enrollees. With new MCO contracts, Kansas can do more than in the past to advance health equity, support children’s health and development, narrow health disparities, and ensure critical community linkages and supports for enrollees.

We can achieve these goals by learning from other states that have leveraged their managed care programs to prioritize community involvement, support primary care by recognizing that prevention is paramount, especially for young children, and investing in innovations that address health-related social needs and the social drivers of health.

As Kansas prepares to solicit bids, the state should leverage strategies that will convey a clear message to prospective MCOs about their expectations and should require MCOs to respond to specific questions aimed at distinguishing their approach to addressing issues of concern to Kansans. For example:

  • How will you ensure that all enrollees have access to the care they need to attain the highest level of health, and how will you improve data collection to track equity improvements?
  • What will you do to focus attention on the health of rural Kansans?
  • How will you deploy community based providers such as community health workers, doulas, community paramedics, home-visitors and peers to ensure that KanCare enrollees have sufficient access to services in community-based settings?
  • Given Kansas’ extension of Medicaid coverage to 12 months post-partum, what will you do to ensure a robust set of benefits are available to this group?
  • How will you ensure a two-generation approach to care, including screening and treatment for caregiver depression?
  • How will you ensure comprehensive screening and effective referrals for health-related social needs, and how will you forge meaningful partnerships with community organizations to address needs?

Kansas can set the expectation of innovation by requiring at least one cross-plan performance improvement plan focused on driving statewide change and use of a public-facing dashboard to contribute to transparency.

The state has the authority — and obligation — to require a level of excellence in health care delivery that can improve health care quality and produce better health outcomes in both the short term and over time. Kansas also can incentivize and assist MCOs to perform at the highest levels, placing significant value on continuous quality improvement.

To focus on improving health, Kansas can ensure KanCare dollars are spent on enrollees’ health instead of administrative costs. Currently, at least 85% of payments to MCOs must go to improving health outcomes, but more can be done. Rather than being penalized, MCOs that don’t meet this obligation should invest the difference in activities that improve health outcomes through strengthening connections with the communities they serve.

Alternatively, Kansas can catalyze further investment in innovation by increasing the MCO’s obligation to provide health coverage to, say, 88%, and allowing MCOs to “count” a portion of expenditures on specific priorities (such as advancing equity, community involvement and reinvestment, attention to health-related social needs and enriching primary care services).

 The best way to ensure there is accountability, transparency and oversight built into the contracts is by the state setting those expectations and planning for it in the contracting process. This should be grounded in thorough and intentional data reporting and as well as consistent and accessible data sharing, especially for race, ethnicity and geography.

Most importantly, throughout the contracting process and implementation of the new contracts, we encourage Kansas to continue to promote opportunities for KanCare enrollees and Kansans to voice concerns about whether the systems are working for them and to improve the health of Kansas. Meaningful engagement, particularly with enrollees and underserved Kansans, will build a better health care system for all Kansans and result in a healthier state.

Public comments about this process are due in early July to be considered by the state government on this important contracting process.

David Jordan is the president of the Hutchinson-based United Methodist Health Ministry FundThrough its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.

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