Centennial Care - New Mexico Medicaid Managed Care

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Program Location: Albuquerque , NM Payer Type: Parent Program: Blue Cross Blue Shield New Mexico Molina Health Care of New Mexico Presbyterian Health Plan United Health Care Community Plan of New Mexico Description:

New Mexico’s new Medicaid program, Centennial Care, is designed to enhance the state’s ability to deliver quality care in a more coordinated, patient-centered manner. The key goals of Centennial Care include:

A requirement of care coordination among providers for each Medicaid recipient, utilizing a comprehensive and integrated health care delivery system, whereby Managed Care Organizations (MCOs) are responsible for all aspects of a person’s health care;
A strong move toward increasing overall health and wellness in New Mexico by paying for quality care and outcomes;
Greater administrative simplicity and a reorganization within the Human Services Department to manage Medicaid more efficiently
A more streamlined Medicaid administration as a result of operating largely under one global waiver, as opposed to 11 different health care waivers – allowing for greater focus on contractor oversight and compliance

Some features of the new Medicaid program include:

An incentives program that rewards healthy behaviors and the use of primary care facilities in order to prevent health problems and reduce chronic disease
Incentives to hospitals to reduce the costly re-hospitalization rate in New Mexico by encouraging follow-up care after discharge

Payment Model:

New Mexico will develop a bundled ambulatory rate to be paid by the MCOs to the lead practices involved in pilot programs for children with asthma and adults with diabetes. The prospective bundled payment will include all primary care, specialist, and diagnostic and medical social work/case management services as an upfront payment to the practices to incentivize maximum management of pediatric asthma and adult diabetes in the community. MCOs will be allowed to withhold a portion of the total ambulatory rate to assess practice performance on specific outcomes including reductions in ER visits and hospital re-admissions.

Improved Patient/Clinician Satisfaction:

The Evaluation found that member satisfaction results largely improved from the baseline to DY2.
Satisfaction rates for care coordination and customer service satisfaction rates also increased for members from the baseline to DY2.

Cost Savings:

The total cost of Centennial Care for DY1, DY2, and DY3 combined is below the budget neutrality limits as defined in the STCs4 by about $2.5 billion, or 15.8%.