As a consultant with MO HealthNet (Missouri Medicaid), CAHSPER’s Associate Director for Policy Partnerships Abigail R. Barker, PhD works with the Missouri Medicaid Office of Transformation to design and help implement value-based strategies across a wide range of efforts.
Examples of MO HealthNet projects and initiatives to which Barker contributed are listed below.
In her role as a consultant with the MO HealthNet Division (MHD), Abigail R. Barker, PhD has contributed to the state’s efforts to improve health outcomes for pregnant and postpartum women and their infants by refining education practices, policies, and payment methodologies. Recognizing that Missouri ranks among the worst states for maternal and infant health outcomes, MHD has organized a set of efforts to increase awareness of available benefits, add non-traditional providers in non-traditional settings, and identify ways to direct resources to achieve better health outcomes.
- Medicaid coverage for doulas in Missouri went into effect October 1, 2024 through a Medicaid State Plan Amendment. This added coverage of doula services for all MO HealthNet enrolled pregnant women to enhance the birthing experience, reduce complications, and improve outcomes for women and infants.
- The Notice of Pregnancy (NOP) and Risk Screening process collects information relevant to clinical and social risk during pregnancy, initiates contact with members to offer prenatal case management services and supports, and updates members’ MO HealthNet benefit category.
- MO HealthNet enrolled providers (including Fee-For-Service and Managed Care Health Plan providers) who provide obstetric care/services, primary care, and emergency care notify the MO HealthNet Division and the Managed Care Health Plans of a participant’s pregnancy in one easy step using the new NOP and Risk Screening Portal. This allows providers to avoid completing multiple forms or online portals.
- The NOP and Risk Screening collects information on the patient’s clinical and social risk factors and needs. Managed Care Organizations use NOP data to determine which members to prioritize, how much outreach to make, and whether a given member’s situation may need Care Management teams to connect with the provider team. Receiving these data allows the state to gain a better understanding of the impact of various social determinants of health risks on outcomes and the effect of mitigating them through early action. It will also be the basis of additional levels of MCO accountability.
- Enhanced reimbursement for Group Prenatal Care improves patient education and includes opportunities for social support. Group prenatal care offers an alternative prenatal care model, aligning with the American College of Obstetricians and Gynecologists guidelines, which emphasizes education and social support via eight to 10 semi-structured, collaborative sessions conducted every two to four weeks throughout the prenatal period.
- New incentive programs for Managed Care Organizations (MCOs) contracted with MO HealthNet have the potential to provide resources in clinical and community settings where gaps exist today.
- The Prenatal Care Adequacy Index (PCAI) incentive program rewards MCOs for ensuring pregnant women receive prenatal visits according to American College of Obstetricians and Gynecologists guidelines, while adjusting for factors outside MCO control. The goal is to reduce maternal morbidity and mortality as well as infant mortality, and potentially to reduce neonatal intensive care unit (NICU) stays.
- The Healthy Birth Weight Incentive program challenges MCOs to decrease their rate of low-birth weight babies year-over-year using any combination of available strategies suggested by clinical and/or social risk factors.
Medicaid managed care dashboards drive transparency and quality.
MO HealthNet Medicaid Managed Care Quality Dashboard
The purpose of the Medicaid Managed Care Quality Dashboard is to provide transparency and accountability in the health care provided to Missouri’s Medicaid participants. MO HealthNet monitors the performance of contracted managed care organizations (MCOs) on a wide range of measures, including Health Effectiveness Data and Information Set (HEDIS) measures and information from the Consumer Assessment of Healthcare Providers and Systems (CAHPS).
Managed Care Health Plans Network Access
In this dashboard, users can view county-level data on whether MO HealthNet Managed Care Health Plans met network access standards in its contracting with health care providers and specialists. Users may also view average distances and minutes it takes to access various types of providers.
The Transformation of Rural Community Health (ToRCH) program addresses critical social care challenges that compromise individuals’ ability to maintain their health and effectively manage chronic conditions. The ToRCH model depends on strong partnerships among three main entities within the rural community: the hospital, primary care and behavioral health clinics, and community-based organizations (CBOs) offering social services. These partners utilize a Community Information Exchange (CIE) platform, Unite Us, which is a secure digital tool that streamlines care coordination by sharing resources, making referrals, and ensuring the completion of the referral process. Each ToRCH hub is managed by a rural hospital whose job includes coordination of community partners and development of a community-level strategy to improve the health of the Medicaid participants in the county. These health improvements should correspond to reduced hospital utilization by those participants, which will then generate shared savings to sustain the model over time. The inspiration for this model draws on Barker’s rural health research findings.
Read a detailed profile about the program from the Rural Health Value project »
A Missouri Medicaid State Plan Amendment updated the inpatient hospital reimbursement methodology that had been in place since 1995, as a bridge to prepare the state to further update to a Diagnosis Related Group (DRG) system, consistent with Medicare and many commercial payers. Claims for services provided to a patient are grouped based on the patient’s primary diagnosis and other clinical characteristics. This grouping is the foundation for a payer’s ability to reimburse in a value-based manner, as rates for DRGs are based on average resource use corresponding to a given diagnosis and severity level across the health care system.