We are pleased to announce the most recent addition to our library of Medicaid dashboards: Missouri. One of the most important functions of easily accessible and digestible data (like a dashboard) is the increased transparency that it offers both Medicaid beneficiaries and advocates. This is especially significant when it comes to holding Managed Care Organizations (MCOs) accountable on a range of child health outcomes.
Missouri’s Medicaid and CHIP programs, called MO HealthNet and MO HealthNet for Kids, offer services through a statewide managed care delivery system. The Missouri Medicaid agency contracts with three MCOs: Healthy Blue, a plan offered by Blue Cross Blue Shield of Kansas City, UnitedHealthcare, and Home State Health, a subsidiary of Centene Corporation. These MCOs are responsible for the care of adults and children in Missouri’s Medicaid program and the children in the state’s separate CHIP program. The dashboard includes health metrics for adults (including two prenatal and postpartum care measures) and several measures for children’s health, though the dashboard is not solely focused on children. In a state like Missouri, where Medicaid expansion was such a hard won battle, as much data as possible for as many beneficiaries as possible will be crucial to ensuring quality and access to care as implementation proceeds.
The HealthNet Managed Care Quality Dashboard is set up so that viewers can directly compare the three MCOs on a variety of quality measures from two sets of data—the Health Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The dashboard is interactive and allows us to compare how each MCO is doing on a particular quality measure (e.g., adolescent well-care visits) with the other two MCOs and with itself in at least the previous year.
The graphic below is an excerpt from Missouri’s dashboard as an example of the kind of information we can expect to find. The grey horizontal bars represent the baseline year, in this case 2018, to which the 2019 data is being compared. The vertical line indicates the national median rate. A blue horizontal line indicates an increase in that measure from the prior year and a red horizontal line indicates a decrease in that measure from the prior year. We can tell that although Home State Health had the lowest rate of adolescent well-care visits in 2019 (49.88%), this was an increase from their 2018 rate by about 2.4 percentage points. This means that in 2019, almost half of Home State Health’s adolescent enrollees had at least one well-care visit with a primary care practitioner.
Missouri’s dashboard also allows for comparisons between the three MCOs based on CAHPS data, which measures data on the patient experience level such as customer service, getting care quickly, getting needed care, how well doctors communicate, among others. Viewers can click through which of these measures they would like to base their comparisons on and see how each of the MCOs measure up.
Another way that beneficiaries and advocates can compare Missouri’s three MCOs on the dashboard is by claims adjudication time. Viewers can look at the average number of days each MCO takes to review and process a claim, either averaged across all claims, or filtered by claim type, health plan region, calendar quarter, and calendar year (the only options are 2020 and 2021 as this dashboard is relatively new). However, there is no information about results—denials, appeals, or reversals upon appeal. This metric, though technical, can offer valuable information about the adequacy of an MCO’s provider network and actual access to services. Additionally, while claims processing data are not commonly found on many state dashboards, and we are glad to see it included on Missouri’s, it is not a particularly helpful metric for children in this case. Of the dashboards we have included in our library, Iowa and Virginia are the only states to post such data and only Virginia designates claims data specific to children’s providers. There is currently no way to parse out claims data that specifically relates to services to children on Missouri’s dashboard.
Of course, there is always room for improvement when it comes to quantity, quality, and transparency of Medicaid and CHIP child health data. To this point, Missouri should at the very least include EPSDT screening rates and enrollment data in their dashboard. Of course we would love if Missouri would follow Ohio’s lead and disaggregate their enrollment data by race and ethnicity, though the quality of their race/ethnicity data does seem to be a concern. Improving collection and reporting methods for race and ethnicity data would be a big step in the right direction toward increased data transparency and child health equity for MO HealthNet and MO HealthNet for Kids participants.
The HEDIS measures on the dashboard include two prenatal and postpartum care measures. Considering Missouri’s current maternal mortality crisis, particularly for women covered by Medicaid, additional measures such as geographic access to OB/GYNs, wait time standards for prenatal and postpartum care, and birth weights (which is included in the maternal core set anyway) would be a good addition to the dashboard.
Finally, in addition to the limited claims adjudication time data included in the dashboard, Missouri should consider including financial data like capitation rates by age group as Ohio does, and medical loss ratios (MLRs), administrative expenses, and profits, as Virginia does. We are glad to see that Missouri has taken this first step toward increased transparency, but we urge the “Show Me” state to up their game to match its neighbor to the north, Iowa.