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Medicaid’s coordinated care program continues to evolve and expand

The Mississippi Division of Medicaid’s (DOM) coordinated care program, MississippiCAN, is now six years old and continues to grow and develop. Integrating a coordinated care model within Medicaid agencies has been a rising trend across the country for at least 20 years, and it is an approach supported by the Centers for Medicare and Medicaid Services.

MississippiCAN was authorized by the state Legislature in 2009 and implemented in January of 2011. The program was developed with the specific goals of improving access to needed medical services, improving the quality of care, and improving cost predictability.

More: Medicaid’s Detailed Response to Navigant’s Operational and Performance Assessment Report – in light of MississippiCAN

Since its inception, MississippiCAN has continually evolved and expanded over six years. In the beginning, the program only applied to a few categories of eligibility (or populations of beneficiaries), such as disabled children at home and the working disabled. The legislature included additional eligible populations and more beneficiaries were rolled into the program in the following years, and in 2015, MississippiCAN was affected by two substantial impacts – the inclusion of all categories of children on Medicaid and inpatient hospital services. Today, approximately 70 percent of Medicaid beneficiaries in Mississippi are served by coordinated care.

When it comes to evaluating the effectiveness of MississippiCAN, it’s important to note that the program has changed every year since it began; there has yet to be a baseline year DOM can use for comparison with other years to demonstrate outcome trends.

For instance, Mississippi leads the nation in preterm deliveries at 12.9 percent, compared to the U.S. average of 9.6 percent. If you just look at that rate among Medicaid beneficiaries, the preterm birth rate is even higher – at 17.1 percent. In fact, DOM covers 71 percent of all premature births in the state. Preterm deliveries are potentially much more costly and have more health complications than full-term births.

As a result of DOM’s collaboration with coordinated care, that number dropped from 20 percent in 2014 to 13.96 percent in 2016, a dramatic decrease in premature births in a very short time.

The CCOs also have been able to track a downward trend in emergency room visits per member per month in the case of beneficiaries with sickle cell disease. In the short term, these two examples are promising, but more substantial data will come once the program has a couple years of stability and continuity.

“While opinions about coordinated care vary throughout the provider community and beyond, I believe it is important to keep things in perspective,” said Dr. David J. Dzielak. “This has been a sea change for Medicaid and for Mississippi, and an enormous undertaking.”

There has been a steep learning curve, but the alternative of the status quo was simply unsustainable, Dzielak added, not only for Medicaid, but also for the health of its residents. Every state is facing similar challenges.

“As anticipated, the benefits of preventive health care can take a long time to show the kind of dramatic impact we all want to see,” Dzielak said. “But improving health conditions in a state with some of the highest health disparities in the nation cannot happen overnight. We are all working together to lay a foundation for a healthier future.”