Best Practices for a Successful Transition to Medicaid Managed Care

One of the largest healthcare programs provided by the federal government, Medicaid, is transitioning from a fee-for-service model to a value-based model of managed care. The Department of Health and Human Services (HHS) provided individual states the freedom, via waivers, to experiment and design new ways of delivering value-based care for Medicaid beneficiaries. As an early adopter of a value-based managed care model, North Carolina is establishing a Medicaid system that has the potential to both restrain costs and improve the quality of care delivered to beneficiaries.

To prepare the transition to a value-based managed care model, states like North Carolina have focused their efforts around successfully executing on:

1. Defining a value-based managed care model that focuses on team-based and person-centered care management functions and responsibilities;
2. Creating a data strategy that standardizes the collection and ease of distribution of health risk scores, initial screenings, quality performance measures, and encounter data across networks of providers and caregivers;
3. Using standardized social determinants of health screening questions to identify and assist patients with unmet health-related resource needs.

Read our report to learn how to plan a successful transition to managed care that includes consideration for Advanced Medical Home (AMH) programs, social determinants of health, and data interoperability and exchange.