Searching for better outcomes and lower costs: The challenges facing state Medicaid directors

October 30th, 2019 / By L. Gordon Moore, MD

70 million people receive health coverage through Medicaid. These programs receive federal & state funding and are administered by state agencies that follow broad federal standards. Eligibility varies across states but in general, Medicaid programs cover a huge number of births, mental health services and long-term care in America.

As you might imagine, Medicaid directors address issues that are familiar to health plans: network adequacy, benefit coverage, pricing, quality, etc., and they do this in the context of complicated political and social issues.

One of the questions I find interesting in the context of a Medicaid health plan: How do we improve coordination of care for people with mental illness when we have separate behavioral health and medical health systems? Some individuals have severe and persistent mental illness (e.g. schizophrenia). These individuals usually receive their mental health care from behavioral health specialists, but if the person also has diabetes, he or she also has to go to a different physician for care of the medical condition. 

This bifurcated system puts people at risk of poor coordination that might result in less than optimal outcomes. Some schizophrenia medications may exacerbate the diabetes, and diabetes management that fails to take the schizophrenia into consideration may reduce beneficial outcomes.

Figuring out how to improve coordination and treat the whole person is just one of many complicated issues Medicaid agencies face. Billy Millwee was the Medicaid director in Texas and works with Medicaid directors and programs across the U.S. In a conversation recorded for the Inside Angle podcast, Mr. Millwee sheds light on how this program works and on other issues important to Medicaid directors.

L. Gordon Moore, MD, is Senior Medical Director, Clinical Strategy and Value-based Care for 3M Health Information Systems.