The right model for Kentucky
A Look At The Numbers provides information on how managed care organizations (MCOs) partner with Kentucky to provide care for a growing Medicaid population.
Medicaid managed care enables Kentucky to deliver higher quality care and improved health outcomes for Medicaid recipients, while managing healthcare costs.
The care people need, when they need it. That is the model of managed care.
Medicaid in Kentucky
Over the past decade, Kentucky’s Medicaid program has evolved into a modern, patient-centered program that serves over 1.6 million Kentuckians. As part of this model, MCOs coordinate healthcare services for nearly 9 in 10 of all Kentuckians enrolled in Medicaid.1
Kentucky’s Medicaid program provides healthcare to individuals facing economic and social barriers, as well as expanded benefits and services to improve their health and well-being. In Kentucky, that population includes 2 in 3 nursing home residents and 3 in 7 individuals with disabilities.2
9 in 10
Kentuckians enrolled in Medicaid covered by managed care
Standards of care
Competitive procurement, strong contract requirements, accredited metrics
Unlike the fee-for-service model, the managed care model is measured against specific quality standards at both the federal and state level. MCOs are accredited and regularly reviewed by state agencies as well as the National Committee on Quality Assurance (NCQA) using up to 69 quality measures.6
In Kentucky, agencies like the Cabinet for Health and Family Services closely analyze health data, consumer assessments, and other metrics to make sure that MCOs are providing the highest quality care.7 These agencies also partner with MCOs on ways to improve health outcomes in the state while simultaneously providing competition and choice for recipients.
Between 2016 and 2019, Kentucky MCOs improved their average score on 75% of individual quality measures.8
Treating the whole patient
MCOs can help treat patients holistically, serving as the glue that binds community resources with integrated physical and mental health services. This approach helps to improve the patient experience, and in 2019, 82% of adults in Kentucky rated their health plan an 8/10 or higher.11
MCOs use information technology and real-time data analysis to develop a comprehensive picture of the member. This approach can help address potential health issues early, like decreased leg circulation as a result of advanced diabetes. After implementing Medicaid managed care, Kentucky saw a 17% decrease in amputations due to untreated diabetes.12
MCOs also help address the social factors that can affect health. Nationally, 77% of MCOs report supporting housing activities, 73% report supporting nutrition activities, and 51% report supporting education activities that aid the Medicaid population.13 Unlike the fee-for-service approach, the managed care model is built to bring together disparate parts of the delivery system.
Helping Kentuckians through the COVID-19 pandemic
MCOs have played a critical role meeting the needs of Kentuckians throughout the COVID-19 pandemic. Through advanced data modeling and analytics, MCOs have conducted outreach to at-risk individuals and ensured lifesaving measures like early testing, continued routine care, extended refills, and access to the vaccine.
MCOs are especially focused on supporting underserved inner city and rural populations, helping to vaccinate the Medicaid population through efforts such as:
- Transportation coordination for plan members.
- Homebound vaccination visits.
- Follow-up on second dose appointments based on claims data.
- Multi-channel outreach to MCO enrollees via calling, texting, and mailing information.
- Gift card incentives ranging from $25 to $100 to encourage individuals aged 12 and older to complete vaccinations.14