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Covering Nevadans when they need it most

A Look At The Numbers provides information on how managed care organizations (MCOs) partner with Nevada to provide healthcare to individuals facing economic and social barriers.

Medicaid managed care enables Nevada 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 Nevada

Nevada Medicaid plays a vital role in improving the health and well-being of some of the state’s most vulnerable. In Clark and Washoe Counties, Medicaid is administered through the managed care model.1

All MCOs are accredited and regularly reviewed by the National Committee on Quality Assurance (NCQA). Additionally, the Nevada Legislature and Department of Health and Human Services provide oversight to MCOs and the Medicaid program.

Program history

In Nevada, MCOs are held to high standards by the state and are accountable for the quality of care they administer.

  • 1997

    Managed care program initiated2

  • 2014

    Nevada expands its Medicaid program to include low-income adults without children3

  • 2020

    Three MCOs service Clark and Washoe Counties4

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Program population

Helping 464,000+ in Nevada5

MCOs are responsible for program administration, including network management, claims payment, care coordination, and utilization management. In Nevada, 97% of Traditional and Newly Eligible Medicaid enrollees receive care from MCOs.6 Medicaid managed care and CHIP cover more than 250,000 children in the state.7
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Reduced costs

Making the budget predictable

With the cost of healthcare rising, managed care organizations help states better plan and manage their budgets. MCOs more efficiently priced care in Nevada at a cost of about $2,800 per case per year, compared to $10,400 per case in the fee-for-service program.8

Improved population health

A higher standard for Nevada

MCOs work to treat the whole person, with a keen focus on preventive services, which save lives and costs.

From 2015 to 2018, among Nevadans in Medicaid managed care, there was a 32% increase in counseling for nutrition and physical activity, and a 14% increase in infants receiving six or more well-child visits from their primary care provider in their first 15 months.9

The number of adolescents who received well-care visits improved 11% between 2015 and 2018, meaning more support for healthy young people and improved likelihood of catching health hazards and conditions before they advance.10

32%

increase in counseling for nutrition and physical activity

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Patient experience

Coordinated care for Nevadans

MCOs coordinate care and provide a single point of contact for Nevadans, creating a better patient experience.

MCOs bring together disparate parts of the delivery system, which allows for comprehensive management that includes partnering with community groups to address social determinants of health. In Nevada, MCOs offer 43 additional services for Medicaid recipients compared to non-managed care models. These services include bus passes, transitional housing, and wellness incentives.12

MCOs also improve access to care through expanded telemedicine and telehealth, new community paramedicine programs, and mobile clinics.

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89%

of parents with children in Medicaid managed care rated their health plan 8 out of 10 or higher in satisfaction.11

Provider experience

Helping states help providers

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Through Medicaid managed care, providers benefit as well. MCOs use value-based payment models that incentivize, empower, and reward providers for the quality of care, not the quantity.

In Nevada, 97% of clean claims are paid to providers within 30 days.13

Citations

http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Reports/NV2018-19_EQR_TR_Report_F1.pdf  
2 http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Reports/NV2018-19_EQR_TR_Report_F1.pdf
https://www.leg.state.nv.us/App/InterimCommittee/REL/Document/13577
4 http://dhcfp.nv.gov/Members/BLU/MCOMain/
5 Powerbigov.us
Powerbigov.us
7 http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Reports/NV2018-19_EQR_TR_Report_F1.pdf
8 NV DHHS, 2019
9 HEDIS Data, 2015-2018
10 HEDIS Data, 2015-2018
11 CAHPS Member Survey, 2019
12 http://dhcfp.nv.gov/Members/BLU/MCOMain/
13 MCO Contractual Terms

A Look At The Numbers is an educational resource about Medicaid managed care, hosted and supported by Medicaid Health Plans of America, in collaboration with other Medicaid managed care organizations and state health plan associations.