Case Study

 

OPPORTUNITY

In the start-up phase of new managed Medicaid expansions, things have to move fast and within budget. Readiness deadlines have to be met and competent teams have to be built. Not an easy task when operating in a tight labor market and shrinking state budgets. This is exactly what a National Medicaid MCO faced as they expanded their operations with a new contract in Texas.

To ensure they met their contractual obligations and provided high quality care for their members, the MCO had to quickly complete several thousand assessments across a wide geographic area. They also had to have a large assessment team created, trained, and ready to contact members in a very short ramp-up timeframe.

SOLUTION

Understanding the time, expense, and resources required to hire full-time nurses and social workers would be a huge obstacle, the MCO partnered with Managed Medicaid Services (MMS) to get started while they built a small, internal core team. Within one week, MMS activated their Virtual Case Manager Network and began to schedule training for the assessment project. Managed Medicaid Services’ comprehensive solution included:

  • Eighty-five RNs and SWs activated to create a “plug and play” assessment team.
  • Online training coordinated with the MCO’s clinical team.
  • Geographic based member assignment and form distribution and maintenance.
  • RN Clinical Consultant to review completed assessments for administrative and clinical accuracy.
  • Secure web portal to delivered completed assessments, on time, to the MCO.

RESULTS

The MCO completed their required initial assessments in accordance with state guidelines, quickly implemented a process for annual re-assessments, and reduced the overall expense associated with FTEs.

Specifically:

  • Of the several thousand assigned to MMS, 70% were completed for their Medicaid member.
  • 97% of the completed assessments met the MCO’s quality standards.
  • MMS and their field team assisted in researching 30% of the assigned assessments that had inaccurate or missing contact information.

The MCO has since utilized MMS’s services in several other states including, NM, HI, GA, PA, FL, and OK.
Using MMS the MCO saved an estimated $694,000 of annual gross FTE expenses.