Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Mco Performance topic
No spam. Unsubscribe anytime.
DLS backs MDH scrutiny of MCO HEDIS declines; MDH adds health-equity accreditation and new incentives
Summary
DLS highlighted a decline in MCO HEDIS performance and recommended reducing some unallocated incentive funds; MDH said it will require health-equity accreditation for MCOs in 2025 and expects alignment of future incentives with the AHEAD primary care model.
The Department of Legislative Services told the Health and Social Services Subcommittee that Maryland’s managed care organizations (MCOs) reported declines on many HEDIS quality measures in calendar 2023 and that more than half of HealthChoice enrollees were in the four lowest-performing plans. DLS asked MDH to explain the decline and to describe how it will determine whether HEDIS problems merit penalties or other corrective action.
Anne Braun summarized DLS’s review of the Population Health Incentive Program (PHIP), which allows MCOs to earn a percentage of their capitated rates for meeting performance benchmarks. Braun said exhibit data show about $19,000,000 in total incentives were paid in calendar 2023, with payments ranging from about $350,000 to $5,000,000 across plans; roughly $17,200,000 had been earmarked but remained unallocated until MDH used $8,000,000 for a health equity incentive.
MDH’s Medicaid Director, Ryan Moran, told the committee the 2025 MCO contracts require health-equity accreditation and that five MCOs — Aetna, CareFirst, Kaiser, UnitedHealthcare and WellPoint — have already achieved it while the remainder have midyear check-ins and a target to complete accreditation by the end of 2025. Moran said MDH expects future population health measures to align with the AHEAD primary-care work and that the department will continue to refine accountability and sanctions policies in MCO contracts.
Why it matters: MCO performance and incentive design affect quality of care for more than 1.5 million enrollees and influence how state funds are allocated to improve health outcomes and equity.
DLS recommended reducing $9,200,000 in unallocated calendar-2023 incentive funds and lowering future incentive funding given fiscal pressures; MDH disagreed with some reductions, arguing that existing contracts and planned accountability measures mean the state should retain funds to reward and enforce improvement. Moran said MDH expects about $25,000,000 will be needed to carry out planned incentive payments and proposed a smaller cut in coordination with DBM through the supplemental process.
MDH also said it will consider whether the health-equity incentive methodology should align with the Governor’s “Enough” neighborhood-level targeting program but noted operational constraints because capitation rate setting currently operates at the county level.
Public testimony and committee questions emphasized concern about declining quality metrics and the need to preserve incentives that drive MCO improvements and support provider networks.
