Nearly 70 percent of Medicaid beneficiaries are now enrolled in managed care organizations (MCOs), with almost half enrolled in safety-net health plans serving primarily lower-income and vulnerable populations. MCOs are increasingly focused on services related to mental/behavioral health. For those receiving treatment for behavioral health services, Medicaid is the single largest payer in the country. MCOs seek to integrate evidence-based, patient-centered solutions and research into healthcare policy and practice to drive quality improvement and patient outcomes in this area. A primary gap is the chief medical officer’s (CMO’s) ability to implement relevant evidence within their local environments once it has been identified.
The Engaging Safety Net Health Plans to Disseminate/Use Evidence to Impact Healthcare Delivery project will support dissemination and encourage implementation of PCORI-funded research to 64 safety-net health plans’ CMOs and quality improvement staff operating in 29 states. Through a variety of engagement vehicles, the Washington, DC-based Association for Community Affiliated Plans (ACAP) will disseminate PCORI-funded evidence related to myriad clinical areas, specifically developing a more robust strategy regarding mental/behavioral health studies, including the creation of a learning collaborative for a subset of member plans. This project aims to build the capacity of ACAP staff to disseminate PCORI-funded evidence to health plans so they can effectively use it in Medicaid decision making and practice.
Further, the project will support the development of a learning collaborative focused on mental/behavioral health services in Medicaid and the dissemination of resources highlighting pertinent information from the learning collaborative to be distributed widely among ACAP plans. This project’s activities will include: convening one in-person meeting per year; conducting topic-specific roundtable conference calls; facilitating online peer-to-peer bulletin board discussions and using a group email platform to disseminate PCOR-led evidence-based research focused on Medicaid populations and policies; and developing a mental/behavioral health learning collaborative for a subset of health plans interested in implementing PCORI peer-reviewed findings on topics specific to their plan.
Projected outcomes include strengthened engagement with ACAP plans and the dissemination of relevant and timely PCORI-funded research through various collaborative platforms. The development of dissemination and implementation strategies by plans participating in the learning collaborative will also be supported. ACAP will support the broader dissemination of pertinent products developed from the learning collaborative to nonparticipating plans and other stakeholders interested in Medicaid managed care. ACAP will use both qualitative and quantitative methods to measure the progress toward project objectives.
ACAP plans’ CMOs and quality managers operate at the intersection of clinical practice, quality improvement, and business operations. Patient engagement and improvement of their health is a critical mission of safety-net health plans. ACAP will engage with CMOs and appropriate health plan staff through in-person and virtual platforms including the learning collaborative. Thus, through dissemination and implementation efforts, ACAP plans can impact health outcomes at the ground level for their Medicaid/CHIP beneficiaries and other related stakeholders.
The enhancement to this project engages Medicaid-focused payers by promoting PCORI evidence through a telehealth learning collaborative. The project team will:
Add a primary focus on COVID-19-relevant topics to its roundtable call series with health plans on PCORI evidence
Add an emphasis on COVID-19-related behavioral health concerns to its Behavioral Health Learning Collaborative
Develop a Telehealth Learning Collaborative with interested plans to encourage peer-to-peer learning and evidence dissemination at a time when plans are ramping up telemedicine capabilities