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MedImpact: The Right Partner for Managed Medicaid

Government

State budgets are under significant pressure with the rising cost of healthcare, and Medicaid typically consumes up to 20% to 25% of state budgets. In many states, Medicaid is the largest investment and expense, surpassing other critical programs such as education.1

In an effort to create a sustainable Medicaid benefit that improves the quality of care while managing costs, states increasingly are moving to managed Medicaid programs.  Half of the states are using or considering a managed Medicaid model, and half of all Medicaid recipients are receiving some form of managed care. By 2020, that number is estimated to reach 85%.2

A critical driver for states to move toward managed Medicaid is a provision in the Affordable Care Act that allows for the expansion of drug rebates to managed care claims. This eliminates some of the financial barriers of moving the pharmacy benefit to a managed care model and opens new possibilities in Medicaid as managed care plans can apply best practices from their commercial populations to Medicaid members.

With the increasing use of managed care comes a focus on the value of better integrated medical, behavioral health and long-term care. This is a step in the right direction; however another key and often untapped area of opportunity is the pharmacy benefit.  Pharmacy is the most frequently used health benefit and provides the greatest opportunity to affect patient behavior, improve outcomes and reduce costs.  Through meaningful pharmacy benefit management solutions, members and providers can make clinically appropriate and cost-effective drug and health choices.

For example, through MedImpact’s Quality Performance Monitoring Program, we can proactively identify Medicaid members at risk for non-adherence and provide tailored interventions before that non-adherence drives expensive medical issues. We leverage pharmacy data and apply advanced analytics to make it actionable. The net result is that we are in an unparalleled position to monitor Medicaid members for gaps in care or unsafe use of medication and take timely action to correct the problem.

MedImpact’s Government Programs and Services (GPS) Medicaid Programs department works in concert with our colleagues within the MedImpact Client and Clinical teams to identify opportunities that result in the delivery of cost-effective, compliance-centric Medicaid pharmacy solutions.

Our conflict-free approach to pharmacy benefit management complements and supports a concerted focus on low net cost, integrated care coordination, and quality initiatives.  We are the right partner for Managed Medicaid.


1. SUMMARY: NASBO STATE EXPENDITURE REPORT. (2015, November 19). The National Association of State Budget Officers. Retrieved from: https://www.nasbo.org/sites/default/files/Summary_State%20Expenditure%20Report.pdf.

2. Pittman, David. (2013, October 21). Managed Care Seen as Future of Medicaid. MedPage Today. Retrieved from: http://www.medpagetoday.com/PublicHealthPolicy/Medicaid/42397.

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