Friday, June 20, 2014
Message from the Director:
Attached for your review is the 2nd quarter performance report for the District’s three full risk-based Medicaid managed care organizations (MCO). The data utilized for this report are generally from the time period of October through December 2013, with some information based on data collected as late as March 2014. While it remains too early in the District of Columbia lifespan of these health plans to report emerging performance trends, as with the first report in this series, this document provides important and instructive data on the operation of the MCOs.
Data in this report reveal that the three MCOs are, in general, financially stable and they get high marks for the improvements witnessed in their execution of key administrative functions. Moreover, it is clear that the health plans are allocating appropriate amounts of revenue from the capitated payments to cover the medical expenses of their members. Most encouraging, we continue to see high primary care utilization rates by adults and children.
Less impressive are the stubbornly low mental health utilization rates, sluggish case management work and the health plans apparent inability to direct a larger number of their members seeking routine care away from hospital emergency rooms. While definitive conclusions about the performance of the plans in delivering effective care coordination services must wait until additional data are available on a more comprehensive set of measures -- likely in the 3rd quarter report -- it seems clear that the MCOs will have to develop strong working relationships with the community of health care providers to leverage the efforts, resources, and expertise necessary to build comprehensive care coordination programs.
I hope you find the information in this report useful.