Medicaid managed care plans employ an array of network enhancing strategies—such as technology-based innovations, provider collaboration, value-based payment, and non-traditional providers—to increase access to and quality of care for beneficiaries. These innovations help individuals obtain the full array of services they need.
As states increasingly enroll Medicaid beneficiaries with more complex and diverse needs into managed care plans, traditional measures of network adequacy—such as physician-to-enrollee ratios or time and distance standards—are important but not adequate. They paint an incomplete picture of how plans enhance network access and delivery of care.
These measures do not reflect how Medicaid managed care plans, working with their provider and state partners, employ strategies that minimize access barriers, embrace new technologies, and create incentives for providers to deliver cost-effective, patient-centered care. Nor do the measures recognize the efforts directed at individuals with multiple or complex conditions or that support individuals who are geographically isolated.
- Network access standards in Medicaid
- Technology-based innovations
- Provider collaboration
- Physician extenders and non-traditional providers
- Policy considerations