Cassie Barrett, BSN, RN* and Matthew Ralls, MPH, Center for Health Care StrategiesApril 1, 2021
Supporting team-based care is an important way for states to advance the delivery of high-quality, comprehensive, and equitable primary care. Team-based care improves health outcomes for patients by enabling primary care practices to offer care that better addresses patients’ unique combinations of medical, behavioral health, and social needs, among others. And a recent Health Affairs article found that care teams outperformed solo providers at managing care for patients with chronic conditions. By employing staff with diverse skillsets who can collaborate, communicate, and work at the top of their licenses (where applicable), practices are better equipped to provide high-quality and efficient patient-centered care. For example, approaches that use care team members who share similar life experiences as the patient, such as peer providers and community health workers (CHWs), are effective at improving outcomes, promoting health equity, and generating return on investment.
Action Plan for Supporting Team-Based Care through Managed Care
1. Establish the Roles of Primary Care Providers and Managed Care Organizations
State Medicaid agencies seeking to encourage team-based care in a managed care program must determine the role that managed care organizations (MCOs) will play in supporting and promoting the model. This will depend on many factors, including: (1) the capacity and sophistication of provider organizations to manage team-based care efforts; (2) familiarity of both MCOs and providers with care delivery models such as patient-centered medical homes (PCMHs) or multi-disciplinary care management; and (3) the presence of other care coordination entities like accountable care organizations to manage the effort. Because MCOs or primary care practices can take ownership of common responsibilities, like care management, it is important that these responsibilities are clearly delineated between the entities to prevent duplication of duties or efforts.
2. Identify Whether to Use a Standardized or Flexible Approach
States promoting team-based care will have to consider how prescriptive to be in directing MCOs or provider organizations managing this work. States can take a prescriptive approach, requiring MCOs to use specific care models selected by the state, thus ensuring enrollees have access to related care and services. For example, a state may wish to connect enrollees with CHWs, and a prescriptive approach can require MCOs and providers to incorporate them into their respective care teams. Alternately, states can set general guidelines that allow MCOs the flexibility to choose and customize program models that may better reflect the needs of their providers and patient populations. Once a strategy is selected, states can use managed care contracts or the MCO procurement process to encourage, incent, or require MCOs or providers to contract with care team members to provide services. For example, Minnesota’s MCO request for proposals asks potential MCOs to describe their plan to use “non-traditional health care services (such as doulas, community EMTs, community paramedics, community health workers, etc.) to provide culturally competent care and/or improve health outcomes.” Michigan’s managed care contract is more prescriptive, requiring MCOs to support the design and implementation of CHW interventions.
While more directive policies and programs will create uniform standards, they may also require more state resources to design, implement, and oversee. Similarly, state-defined standards for PCMH programs, staff training, and certifications would also require more state involvement, rather than adopting existing external models or allowing MCOs flexibility to use their own approaches. States can also attempt to reduce administrative burden — on themselves and other stakeholders — by aligning team-based care models with other initiatives.
3. Determine How to Compensate Providers for Team-Based Care
New reimbursement pathways are critical for supporting the adoption of team-based primary care teams. Examples include increased reimbursement rates for practices recognized as PCMHs, as well as additional or enhanced per member per month (PMPM) payments for care coordination and other team-based care activities a state or MCO wants to prioritize. Oregon uses the latter approach, requiring its Coordinated Care Organizations to provide supplemental PMPM payments to the state’s Patient-Centered Primary Care Home clinics to support the development of infrastructure and operations.
States can also create billing codes for team-based care activities. For example, Washington State created new billing codes for primary care teams to use the collaborative care model to address the behavioral health needs of patients; while Minnesota’s medical assistance program uses billing codes that cover care coordination and patient education services provided by certified CHWs.
Additionally, states can consider providing MCOs with value-based payment (VBP) incentives to drive the adoption of team-based care among primary care practices through incentive or penalty arrangements. States that wish to be directive can require MCOs to meet targets or metrics related to team-based care initiatives, such as member enrollment in PCMHs or number of enrollees served by certain types of care team members. For example, New Mexico requires that at least three percent of enrollees are served by CHWs or Community Health Representatives. States can also incorporate team-based care elements into MCO care management requirements or within performance improvement projects, VBP initiatives, or Section 1115 demonstration projects or pilot programs.
Takeaways and An Opportunity to Learn More
States looking to promote team-based care can facilitate this effort in a way that not only achieves their goal of delivering optimal care for patients, but also supports MCOs, primary care practices, and care team members. To employ team-based care as an enhancement to primary care, states can explore what configuration and funding methods will enable and incentivize MCOs and providers to do so effectively and efficiently.
To further explore this issue, CHCS will be examining how states and MCOs can partner to support team-based primary care in an upcoming webinar on April 15 at 1 pm ET. The webinar will focus on building a team-based care approach at the provider level and using MCO contracts to encourage team-based care. It will feature innovations from a state Medicaid program, Oregon Health Authority, and a provider support organization, National Health Care for the Homeless Council.
*Cassie Barrett is an intern at the Center for Health Care Strategies