Riding the reform rollercoaster
Medicaid expansion and physician-practice participation in federal and state PCMH programs have had profound impacts on Arkansas BCBS.
"Medicaid expansion did impact us in a big way here," Spaulding says.
"In Arkansas, they expanded Medicaid, which had a qualification point of about 18% of the federal poverty level, to 138%. And they decided to do that by getting federal money to purchase commercial insurance on the exchange. We got 140,000 people in Medicaid expansion, and we've learned a lot over the past two or three years. We originally thought these people might be a lot more like our commercial population than the historical Medicaid population, but what we found out was they probably were more like the traditional Medicaid population. We need to beef up our acute-care coordination services and our behavioral health services," he says.
In anticipation of serving thousands of Medicaid expansion beneficiaries, Arkansas BCBS boosted care management capabilities in 2013, says Maxine Greenwood, director of governmental and media relations at the health plan.
"We have community-based case managers in all areas of the state who use hospital census and discharge information to reach out to members who have been hospitalized. They also get referrals from providers and use emergency department and claims information to identify members with medical and behavioral health needs," Greenwood says. "Our case managers work closely with social workers and behavioral health staff to promote quality collaboration and care coordination for high-risk members with complex behavioral health conditions and for those with both medical and behavioral health needs. Community-based case managers are also familiar with local resources outside of the health plan that may benefit members with transportation and other services."
Since Arkansas BCBS started serving Medicaid expansion beneficiaries in 2014, the health plan has launched additional initiatives, including a telemedicine pilot designed to ease reimbursement for behavioral health services, she says.
Christopher Cheney is the senior clinical care editor at HealthLeaders.