{"id":7053,"date":"2024-12-12T14:58:29","date_gmt":"2024-12-12T20:58:29","guid":{"rendered":"https:\/\/healthfund.org\/a\/?p=7053"},"modified":"2024-12-12T14:58:29","modified_gmt":"2024-12-12T20:58:29","slug":"medicaid-managed-care-contracts-philanthropy","status":"publish","type":"post","link":"https:\/\/healthfund.org\/a\/medicaid-managed-care-contracts-philanthropy\/","title":{"rendered":"Medicaid managed care contracts are a powerful tool for change; philanthropy has a role to play"},"content":{"rendered":"
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David Jordan<\/strong>, President and CEO,\u00a0United Methodist Health Ministry Fund<\/em>
Katie Schoenhoff<\/strong>, Vice President of Programs,\u00a0United Methodist Health Ministry Fund<\/em>
Donna Cohen Ross<\/strong>, Owner,\u00a0DCR Initiatives, LLC<\/em><\/p>\n\n\n\n

This article originally appeared in Grantmakers in Health<\/a> as part of its “Views from the Field” series on Dec. 9, 2024.<\/em><\/p>\n\n\n\n

Medicaid managed care contracts are a powerful tool for change; philanthropy has a role to play<\/h3>\n\n\n\n

As a foundation, the mission of the United Methodist Health Ministry Fund (the \u201cHealth Fund\u201d) is to improve the health of all Kansans. Our success, in large measure, depends on investments we make in advancing positive policy and systems changes that affect the state and communities. So, with large numbers of the state\u2019s most vulnerable people relying on Medicaid for health coverage and care, we focus on leveraging the opportunities this program offers to sustain improved health outcomes and make progress on health equity.  <\/p>\n\n\n\n

Today, as we enter a time of increased social and political uncertainty, with Medicaid\u2019s structure and finances under threat, such efforts are more crucial than ever: philanthropic organizations like ours must continue to move forward, as well as act to preserve and protect the significant policy gains achieved over time.<\/p>\n\n\n\n

This View from the Field<\/em> describes how the Health Fund, working along with numerous stakeholders throughout Kansas, went \u201call in\u201d on a multi-year effort, beginning in 2021, to shape the reprocurement of our state\u2019s Medicaid managed care contracts for KanCare, the state\u2019s Medicaid delivery system. This key process establishes and amplifies the state\u2019s  health care priorities for the next several years and defines the expectations it holds for all managed care companies that wish to deliver care to Medicaid enrollees.  By getting involved at the earliest point in the process \u2013 as the state\u2019s Request for Proposals was being developed \u2013 we had a better chance of assuring that the resulting contracts would align with what we have learned from the research, innovation, and experience at the core of our grantmaking.<\/p>\n\n\n\n

Sharpening our focus<\/h3>\n\n\n\n

KanCare plays an integral role in the health of many of the most vulnerable people in our state, serving more than 415,000 Kansans<\/a>\u2014the majority of whom are children. The program also serves pregnant women, parents, people with disabilities, and the elderly.<\/p>\n\n\n\n

The Kansas Department of Health and Environment contracts with three private managed care organizations (MCOs) to deliver care to KanCare enrollees. With these contracts scheduled for rebid in 2023-24, we thoroughly invested ourselves in the reprocurement process.<\/p>\n\n\n\n

We wanted the state to prioritize people<\/em> in its Request for Proposals (RFP), challenging bidders to describe the distinguishing approaches they would employ to improve Kansans\u2019 health. The process presented a chance to increase access to care and address the social drivers of health\u2014non-medical needs, such as nutritious food, safe housing, and educational and employment opportunities. In doing so, we could reduce health disparities and advance health equity.<\/p>\n\n\n\n

We advocated that the agency prioritize enhancing KanCare enrollees\u2019 experience and satisfaction with both the insurers and health system, as we firmly believe the Medicaid program should focus on improving how the patient interacts with the program to encourage more eligible users to participate.<\/p>\n\n\n\n

As we developed our strategy, we sharpened our vision for how KanCare could best serve its enrollees and providers. Our work focused on developing robust, evidence-backed comments on the RFP and encouraging fellow foundations to join us and the many other stakeholders participating in the process.<\/p>\n\n\n\n

Our colleagues at REACH Healthcare Foundation<\/a> and Health Forward Foundation<\/a> convened an event attended by state policymakers, which created an opportunity for partners and grantees to share concerns and identify priorities. The Kansas Health Institute<\/a> developed a report from this stakeholder meeting<\/a>, which became a valuable tool for the state and our efforts.<\/p>\n\n\n\n

We also utilized other resources that became instrumental in helping shape our comments. With support from The Commonwealth Fund<\/a>, Medicaid experts at George Washington University and elsewhere built a searchable database drawn from over 40 current Medicaid managed care contracts.<\/a> This enabled us to illustrate our comments with specific language collected from states already implementing the practices we were counting on KanCare to adopt. In addition, resources from the Center for Health Care Strategies, Bailit Health<\/a>, and State Health and Value Strategies<\/a> were helpful in informing our approach and comments.<\/p>\n\n\n\n

Crafting strategic feedback<\/h3>\n\n\n\n

We submitted four sets of comments addressing specific areas of concern, making the case that:<\/p>\n\n\n\n