Medicaid Managed Care: Evolution and Impact of Value-Driven Healthcare

A Comprehensive Study by the Association for Community Affiliated Plans, Medicaid Health Plans of America, and National Health Care Consulting Firm Sellers Dorsey  

Philadelphia, PA— Three organizations involved with nationwide Medicaid initiatives—the Association for Community Affiliated Plans (ACAP), Medicaid Health Plans of America (MHPA), and Sellers Dorsey, a national health care consulting firm with deep expertise in Medicaid—are collaborating on an analysis of the history, present state, and outcomes of Medicaid managed care. The use of managed care in Medicaid is widespread throughout the U.S. as states are increasingly focusing on quality, access, value-based care, and innovation. The report is expected to be released later this year. 

“The use of managed care plans in the delivery of care within the Medicaid Program is continuing to grow throughout the U.S.,” remarked Leesa Allen, Managing Director at Sellers Dorsey. “States are increasingly moving to utilize managed care to serve additional complex populations, improve the quality of and access to care, and encourage the adoption of value-based payment arrangements.”  

This collaborative project will focus on five core areas: (1) the scope of the Medicaid managed care industry as a whole, including enrollment, revenue, and number of plans; (2) the evolution of federal oversight, including the Balanced Budget Act of 1997, the Affordable Care Act, and the various federal regulations regarding managed care; (3) states’ approaches to contracting with plans and implementing managed care; (4) the operations of managed care organizations (MCOs); and (5) outcomes of managed care, including cost containment, access to care, and quality of care.  

“We’re honored to take on this important project with our esteemed partners in managed care,” said Gary Jessee, Senior Vice President at Sellers Dorsey. “The scope of the study and expertise of our researchers will make the forthcoming report extremely valuable to policy makers and those who are interested in better understanding the role of managed care in Medicaid.” 

This study coincides with the 25th anniversary of the passing of the Balanced Budget Act of 1997, which was a major first step in creating federal rules for Medicaid managed care. The research is spearheaded by a partnership of three organizations that facilitate collaboration among health care experts throughout the nation to drive progress in Medicaid. As more states transition to or strengthen Medicaid programs based on quality of care rather than volume, looking back at the evolution and impact of the first 25 years of managed care will offer strategic insight to these and other organizations working to improve health care outcomes in Medicaid.  

Researchers from ACAP, MHPA, and Sellers Dorsey believe the report will be an invaluable resource for understanding the history and present state of Medicaid managed care. The document will allow readers to consider the various strategies that different states and MCOs employ in the pursuit of states’ unique population health goals. Stakeholders across the health care spectrum—such as health care providers, government officials, community-based organizations, Medicaid program participants, and others—will find relevant information in the forthcoming report.  

About ACAP 

The Association for Community Affiliated Plans (ACAP) is a national trade association which represents nonprofit Safety-Net Health Plans. Collectively, ACAP plans serve more than twenty million enrollees through Medicaid, Medicare, Marketplaces, and other public health coverage programs. ACAP’s mission is to strengthen nonprofit Safety-Net Health Plans in their work to improve the health and well-being of lower-income people and/or people with significant health needs. 

About MHPA

Founded in 1995, the Medicaid Health Plans of America (MHPA) represents the interests of the Medicaid managed care industry through advocacy and research to support innovative policy solutions that enhance the delivery of comprehensive, cost-effective, and quality health care for Medicaid enrollees. MHPA works on behalf of its 130+ member health plans, known as managed care organizations (MCOs), which serve nearly 43 million Medicaid enrollees in 40 states, the District of Columbia and Puerto Rico. MHPA’s members include both for-profit and non-profit, national and regional, as well as single-state health plans that compete in the Medicaid market.