Medicaid managed care organizations (MCOs) play an essential role in the American healthcare ecosystem, with nearly 70% of Medicaid beneficiaries enrolled in comprehensive managed care plans across the country. MCOs—health plans contracted by states to deliver healthcare services to Medicaid beneficiaries—are risk-based, and often incorporate payment schemes and incentive programs to increase profits and improve their members’ quality of care.
While the state contracting the MCO chooses how to administer the program, capitated managed care is the most widespread model in use today. MCOs are paid a flat rate per member covered, and in turn provide coverage to their population through their own network of providers. Because MCOs are paid a flat rate per patient, they often seek population-level solutions to improve member’s clinical outcomes and reduce healthcare utilization, which subsequently increases profit margins. Innovative mHealth solutions are also a means to market and better compete in an increasingly digitized healthcare economy. emocha’s mobile platform for medication adherence enables MCOs to accomplish these goals and better serve their patients.
Medication nonadherence is a widespread and critical problem for Medicaid MCOs: nonadherent patients are more costly than adherent ones, and quality metrics such as the HEDIS measures are directly linked to reimbursement. As costly prescriptions and specialty medications become more prevalent, MCOs are spending more and more on prescriptions for patients. Given that medication is not taken as prescribed 50% of the time among patients with chronic diseases, MCOs should demand better oversight to ensure proper utilization of medications.
emocha’s solution uses video Directly Observed Therapy, a CDC-endorsed technique that confirms each dose of medication via asynchronous video. This enables us to confirm dose-by-dose adherence: the most accurate and precise measure of adherence. Achieving true adherence leads to better possession metrics such as Medication Possession Ratio (MPR) and Portion of Days Covered (PDC), and helps with disease-specific metrics including Asthma Medication Ratio (AMR). emocha’s case studies with pediatric asthma and type 2 diabetes populations demonstrate the effectiveness of our approach for members and their respective health plans.
When emocha’s platform was used for pediatric asthma patients from a Baltimore City community hospital asthma clinic, we saw a decrease in emergency department visits and hospitalizations, with hundreds of medication and technique errors detected and resolved through our program without escalation back to the provider. In a pilot program with a Medicaid health plan for diabetes, members proved 86% medication adherence and a satisfaction rating of 4.6/5. This adherence resulted in a decrease of 1.7 HbA1C across the initial enrolled members.
Within 90 days, emocha’s solution can improve clinical outcomes and provide a robust ROI of up to 5X to health plans. Patients with asthma, diabetes, and hypertension who use emocha improve their inhaler technique, asthma control scores, HbA1C, and blood pressure. When patients are adherent to medications, they have fewer hospitalizations, readmissions, and ED visits. Adherence also helps patients avoid disease progression and more expensive treatment, saving thousands of dollars in cost per patient per year—benefits that accrue directly to MCOs hoping to improve patient outcomes and decrease costs. As Medicaid MCOs look for strategies to make their risk-based model successful for patients and financially sound, emocha’s digital health platform is a proven solution.
