LAURIE VANHOOSE, MADELEINE RICHTER-ATKINSON
Treaty Oak Strategies
Texas, like many states, adopted the managed care model for the administration of its Medicaid program. Through this model the state contracts with health plans or managed care organizations (MCOs) that are responsible for managing the day-to-day operations of the program. In addition to leveraging the private market experience of health plans, the managed care model creates numerous opportunities for states to contain Medicaid costs while improving health outcomes and quality of care. MCOs can also go beyond providing standard medical and mental health services by identifying beneficiaries’ non-medical needs and connecting them to community supports.
In Texas, Episcopal Health Foundation (EHF) launched a partnership with key stakeholders over six years ago to harness the capacity of MCOs in addressing non-medical needs of Medicaid members. In 2018, EHF partnered with the Texas Association of Health Plans (TAHP) and the Texas Association of Community Health Plans (TACHP) to conduct the first-ever Texas survey capturing Medicaid health plans’ activities to address non-medical drivers of health (NMDOH). Survey findings published in a 2019 Health Affairs blog article revealed that while Texas MCOs are committed to addressing NMDOH, financial challenges and a lack of understanding of Texas Medicaid policies that authorize MCOs to advance NMDOH activities prevent implementing, incentivizing, and sustaining non-medical health interventions.
This collaborative effort culminated in a partnership between EHF, TAHP, TACHP and Texas Health and Human Services Commission (HHSC) to form the Texas MCO NMDOH Learning Collaborative in 2019. The Robert Wood Johnson Foundation was also an early financial supporter and thought partner of the Learning Collaborative in 2019. This year, the Learning Collaborative will kick off its sixth year – rare for a collaborative of its sort – thanks to continually-growing interest in participation. Support also grew to include funding from the Michael and Susan Dell Foundation. Treaty Oak Strategies and the Center for Health Care Strategies continue to organize, facilitate, and support the Learning Collaborative.
The Learning Collaborative’s work has contributed to key legislation and policy changes that advance the NMDOH work of Medicaid MCOs to continually improve the health and well-being of their members, including:
- adoption of a state NMDOH Action Plan,
- state guidance to the MCOs on using Quality Improvement to support NMDOH activities,
- an alternative payment framework that credits MCOs for engaging community-based organizations (CBOs) and NMDOH interventions,
- NMDOH policy recommendations developed by HHSC Value-Based Payment and Quality Improvement Advisory Committee to the state legislature, and
- passage of legislation aimed at improving the NMDOH needs of pregnant women.
Over the past five years, the Learning Collaborative has tackled a wide range of topics, from improving maternal health and access to transportation services to best practices for engaging Medicaid members, CBOs and community health workers (CHWs), and everything in between. Each year, the Learning Collaborative promotes new topics, ideas and collaborations, and participants share their newest best practices, and year five was no different.
Year Five (2024) Highlights
March 1, 2024, marked a historical day in Texas: the launch of 12 months post-partum Medicaid coverage. On the same day, the Learning Collaborative kicked off its fifth year. The year prior, Texas saw the passage of two important maternal health bills: 12 months Medicaid postpartum coverage and HB 1575, which requires the state to develop a standardized MCO NMDOH screening tool for pregnant women and allows CHWs and doulas to bill for Medicaid case management services. The state and other entities engaged in the Learning Collaborative used the platform to educate and seek feedback from MCOs and stakeholders about the implementation of these bills.
Engaging Medicaid Members
In February 2024, EHF published Engaging Medicaid Members: Identifying the Non-Medical Needs of Pregnant Members. Several funders and MCOs partnered to hold conversations with Medicaid members who were or recently had been pregnant to hear directly about their experiences and support needs. In addition to transportation, housing, and employment, many of the women identified childcare and lack of access to reliable pregnancy education as critical NMDOH needs. Additionally, many members lacked knowledge of the services that Medicaid offers, such as transportation and other value-added services. The Learning Collaborative used findings from this report to drive the agenda for the fifth year, which included identifying ways to better inform Medicaid members about the benefits available to them through their Medicaid coverage.
The report identified a gap in knowledge among Medicaid members about medical and non-medical services MCOs offered to them. For stakeholders to effectively address Medicaid enrollees’ self-identified non-medical needs, they must be able to deliver information about services in a form that members will receive and understand. In response to these findings, EHF, along with other peer funders, again partnered with Treaty Oak Strategies and eight MCOs to hear from Medicaid enrollees and published Engaging Medicaid Members: Assessing Health Literacy and Channels for Member Engagement. Ensuring that Medicaid beneficiaries are involved in conversations about their own well-being is a crucial step in improving access to care. Findings demonstrate that MCO investment in outreach through service coordinators is extremely helpful for members and information shared also helped identify additional steps MCOs can take to improve members’ access to care and understanding of covered services. The focus groups also show that implementation of twelve months post-partum coverage already had an impact on pregnant women gaining access to much needed maternity related care that they would not have received without postpartum coverage.
To further support inclusion of Medicaid Members’ voices, Center for Health Care Strategies hosted a Learning Collaborative webinar on Medicaid member engagement and provided an overview of the new managed care rules that require the state to develop a member advisory committee.
Supporting CHW and Doula Engagement and Facilitating Community Connections
Implementation of HB 1575
The Learning Collaborative worked closely with HHSC on the implementation of HB 1575 by providing feedback to the agency on the new NMDOH screening tool for pregnant women, connecting MCOs and HHSC with CHW and doula groups in Texas and helping facilitate feedback on policies implementing the legislation. To help MCOs and other stakeholders better understand the current landscape of CHWs in Texas, the Learning Collaborative hosted a webinar that provided an overview of a study funded by EHF and conducted by the Texas Association of Promotors/Community Health Workers, The University of Texas at Arlington and the Department of State Health Services on the current landscape of CHWs in Texas.
In March and November of 2024, EHF helped coordinate two stakeholder meetings for the state and MCOs to educate CHWs and doulas on the processes it takes to become an enrolled, contracted and credentialed Medicaid provider under the rollout of HB 1575.
ARPA-H HEROES
Multiple entities in Texas expressed interested in applying for the ARPA-H HEROES grants, a project that “brings together public health entities and collaborators to improve the health status of their communities for specific patient populations as the program evaluates a new payment model that incentivizes community-based interventions to improve health outcomes across a fixed geography.” To help facilitate the development of relationships between payors and interested organizations the Learning Collaborative hosted a webinar in April introducing ARPA-H HEROES.
Waco Connect
During an in-person meeting, the Waco Connect project was highlighted as an opportunity to share lessons learned. Waco Connect is a social care navigation program coordinated between April 2021 and February 2023 by Prosper Waco in Waco, Texas. The initiative aims to connect families experiencing mental health needs in McLennan County to a network of non-medical resources. In partnership with Baylor Scott & White Health, the families of Medicaid-enrolled children (under 19) who have serious anxiety and depression were selected and provided the opportunity to be linked to social care providers through referrals. EHF published an evaluation of the project in June 2024.
APMs & Value-Based Payments
Nationally, states are moving away from paying for quantity and moving toward paying for quality. In Texas, HHSC requires MCOs to develop alternative payment models (APMs) with providers to help advance quality of care, reduced costs, and improved health outcomes.
An APM is a contractual arrangement between a MCO and a provider to encourage innovation, quality and efficiency and rewards providers for quality of care rather than volume of care delivered. Today, HHSC requires MCOs to have at least 50% of payments in some form of an alternative payment model and recently released a new APM framework to help further encourage the development of APMS with various providers and populations and even gives MCOs credits for including CBOs and NMDOH interventions in their APMs. The Learning Collaborative has provided a platform for HHSC, MCOs, and providers to discuss opportunities to leverage APMs to pilot or implement models of care that address not only medical needs but the non-medical needs of Medicaid Members.
To help support providers in implementing APMs, multiple provider groups have established Clinically Integrated Networks (CINs). MCOs also see value in the CINs and to help encourage the development of APMs, the Learning Collaborative hosted a webinar on Alternative Payment Models Best Practices. In this webinar, Dell Medical School facilitated an overview of three of the Clinically Integrated Networks in Texas – Rural Hospitals, FQHCs, and Community Pharmacies.
HHSC’s Value-Based Payment and Quality Improvement Advisory Committee (Quality Committee) is another group in Texas that continues to promote public-private, multi-stakeholder collaboration in support of quality improvement and value-based payment initiatives for Medicaid. Given the alignment of the Quality Committee and the Learning Collaborative’s work, several members serve on both initiatives and each year Quality Committee members provide updates on their recommendations at the Learning Collaborative sessions. The Quality Committee also established a subcommittee on NMDOH that explores opportunities to integrate NMDOH interventions into APMs and complements the work of the Learning Collaborative.
Looking Ahead
In March 2025, the Learning Collaborative hosted the first meeting of Year Six. This year, the group plans to continue to build momentum around NMDOH screening by bringing together providers and MCOs to learn best practices, identify barriers and explore ways to share data. Additionally, the Collaborative will highlight multiple new reports, including a report focused on utilization of Non-Emergent Medical Transportation, a report on the cost of diabetes to the state of Texas and a report that reviews maternal health and cost drivers in the Medicaid program. The MCO NMDOH Learning Collaborative will continue to be a platform to share the innovative approaches MCOs, providers, and CBOs are taking to drive continuous improvement in the quality of care and the health of all Texans.
More from Digging Deeper
Texas’ Medicaid Managed Care Learning Collaborative: Origin, Contexts, and Key Takeaways from 2024 Efforts
Episcopal Health Foundation (EHF) launched a partnership with key stakeholders more than six years ago to harness the capacity of MCOs in addressing non-medical needs of Medicaid members. The Learning Collaborative’s work has contributed to key legislation and policy changes that advance the NMDOH work of Medicaid MCOs to continually
Understanding Community Health Through Data Mapping
EHF’s research team has released an updated and improved County Health Snapshots data mapping tool. EHF’s County Health Snapshots (CHS) tool provides a peek into the important demographic factors and health outcomes within the EDOT.
Key Takeaways from EHF’s Policy and Research Reports in 2024
As a major health philanthropy in Texas, EHF has developed a diverse range of tools, both financial and non-financial, that help to improve the health of all Texans.
