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were very sick, needing attention from case managers for cancer or heart surgery,” recalls Kendall. Even those without life-threatening care demands brought surprising strains to the system. “It seemed like every one of the new Healthy Michigan enrollees went to a dentist on day one.”
By 2015 this massive Medicaid in ux had been absorbed into McLaren Health Plan, and members were receiving much-needed care. “Statewide, 600,000 people are getting care they never could before,” notes Kendall. “This has been a very positive program.”
Though the Medicaid expansion tested the McLaren system, Kendall nds the nancial impact has been slightly positive, as the
reimbursement premiums were slightly higher than for regular Medicaid which helps to more fully cover the expenses of providing care.
Even more transition has recently occurred with the state’s Medicaid program. Medicaid managed care contracts through providers such
as McLaren are rebid every few years to assure the best value and coverage. In previous years, an established point system was used
so providers could aim for objective targets on items like quality and access. But for the 2015 rebid, more subjective measures were in
the works, as well as new handicapping for value-based payment methodologies, patient-centered medical homes, behavioral health integration, and coordination with services outside the health plan contract. Geographical boundaries were also revamped, based on the state’s 10 new “Prosperity Region” zones. Providers like McLaren Health Plan had to bid on much larger territories, rather than county by county. The good news is that McLaren Health Plan was awarded the bid to o er its Medicaid product throughout the entire lower peninsula of Michigan — one of only three plans to be awarded this entire region. The challenge, Kendall adds, is that “the state is already struggling with its budget, so we assume we’ll be looking at a reduction in premiums.”
are getting care who never could before.
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2015 ANNUAL REPORT