How Medicaid plans can build fundamental trust with providers

In a decade leading the Illinois Association of Medicaid Health Plans, CEO Samantha Olds Frey has worked to build managed care in the state from the ground up, winning "hard-fought" trust from providers. 

The association represents six managed care plans, including Humana, Aetna and BCBS of Illinois, managing Medicaid care for the state's 3.9 million members. 

Ms. Olds Frey sat down with Becker's to discuss the current state of Medicaid in Illinois and her hopes for the future. 

Responses have been edited for length and clarity. 

Question: You're celebrating 10 years leading the Illinois Association of Medicaid Health Plans. What's the biggest change you've seen during that time? 

Samantha Olds Frey: It's hard to pick just one. In Illinois, I'll say it's the partnership between providers and plans. We were really late to Medicaid managed care here in Illinois. We really didn't have much of a program until about 10 years ago, and when we came in with a care coordination program it really changed the system. So building that trust in those relationships, it was hard-fought, and took time. 

From a broader perspective, zooming out and stepping away from just what we have seen in Illinois that has changed to what has changed across the country, I think is an increased focus and acknowledgement of health-related social needs, and what is the role of the Medicaid program in addressing those. It wasn't a mystery to anybody who worked in the Medicaid space that housing, food insecurity, transportation and employment all impact our healthcare outcomes. But typically, the next part of that sentence was, "Medicaid doesn't cover housing, Medicaid doesn't cover food, Medicaid doesn't cover X, Y or Z." Now I think we see a real transition in the conversation to, "How could Medicaid cover this? What can Medicaid do? Not just in small pockets, but what can we do writ large?" That's a real shift in our focus from a national perspective, and a welcome one at that. 

Q: Medicaid redeterminations are top of mind for leaders everywhere. What are you seeing in Illinois, and how is your organization involved? 

SOF: We're really lucky in Illinois. We have a state that wants to get it right, wants to maintain eligibility for those who are eligible, wants to have a smooth transition for those who are not eligible any longer, so that a loss of eligibility doesn't mean a loss of coverage, it simply means a transition. We are meeting regularly. The state is answering our questions, listening to our ideas, asking what we're doing, asking for outcomes — what's working, what's not, and sharing best practices. 

In terms of what we're doing, it's probably easier to say what we aren't doing. We're trying everything. We're working with community-based organizations like food pantries, homeless shelters, the providers that serve our members on a regular basis. We are texting, we are emailing, we are calling, we are mailing, we are knocking on doors, we are doing social media ads, we are doing paid media. … We're trying everything, and if anybody has some idea, we welcome that, because we want to get this right. And we don't want people falling through the cracks because of paperwork. 

Q: Some providers are splitting with Medicaid managed care plans. Do you have any advice on how to preserve those relationships?

SOF: There are things we can't fix. I think it's important to just acknowledge those. At least here in Illinois, Medicaid reimbursement rates are a challenge. You can move a little bit there, but you can't move a lot. Those are challenges that plans can't necessarily solve for. 

I think what we can solve for, what we have been able to solve for here in Illinois, is to take those other bureaucratic processes, administrative processes, that cause frustration for the provider community and address them, and take them off the table. … There are certain things we have solved for and standardized that have made a real difference. We have a standardized roster template across all health plans, so a provider can complete their roster once and submit it to all of our Medicaid health plans. That makes it easier for the provider, but on the other side, the plans get better information. 

Q: What do you hope Medicaid looks like 10 years from now?

SOF: I would like to think I spent the first 10 years really building trust and partnership between providers and plans, solving what I would call fundamental challenges in terms of making sure everybody agrees on the rules of the road of billing: This is what you need to do in order to get a claim paid, or to file an appeal, and we will return your phone calls. That is fundamental. We've spent a decade building that fundamental trust in Illinois, through rocky starts and fits and progress, then two steps back, but we've really come to a place that I'm quite proud of. 

I think the next step of that is: How do we innovate now? There is a reason we left a fee-for-service system. There is no magic in the fee-for-service rate. How do we begin, in real earnest, to deploy in the Medicaid program, value-based contracting. How do we really tie reimbursements and providers to the quality of the outcomes that they're achieving? How do we encourage them to move the needle on some of these really challenging clinical areas, and how do we walk alongside them and support them in doing so? My hope is, that's what we talk about for the next 10 years: how do we collectively change the system to better serve and meet the needs of Medicaid members and improve outcomes overall?

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