Pursuing the Triple Aim in managed care: Value-based default enrollment

Some state Medicaid agencies leverage the enrollment process  to drive health plan improvement.  Within states that operate Medicaid managed care, there are typically high percentages of individuals newly enrolled in Medicaid that are eligible for enrollment in a health plan, but do not select a plan (i.e. “default enrollments”).  Medicaid agencies contract with enrollment brokers that develop formulas for determining the monthly default enrollment allocations for each contracted  health plan within specific geographic markets. Some Medicaid agencies further adjust each health plan’s default allocation by incorporating quality measurement scores into their default allocation formulas. This increases or decreases each health plan’s default allocation, depending on their relative quality scores and how much weight is assigned to those scores.

Texas Medicaid recently implemented a novel approach to drive value in the default enrollment process, leveraging our rigorous methodologies.

An analysis of this issue estimated that the adoption of smarter defaults would lower spending in Medicaid by approximately 1%, without adversely impacting health outcomes or enrollee satisfaction. Click here to read the full study.