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MEDICAID MANAGED CARE: See How Companies Scored

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A team of four reviewers (all DHS employees) scored each of the 11 companies that submitted bids to manage Iowa's Medicaid system.  Companies were able to get a total of 100 points - the four companies with the highest scores would be awarded the contract.  You can see the final scorecard here.

Here is how each company ranked, with their score:

  • Amerigroup - 78
  • United - 77.25
  • WellCare - 68.75
  • Amerihealth - 63.25
  • Iowa Total Care (Centene) - 60.25
  • Aetna (Coventry) - 56.5
  • Magellan - 51.75
  • Molina - 41.25
  • Medica - 40.75
  • Meridian - 35
  • The eleventh company - Gateway - did not submit a bid.

While Iowa has chosen to award the contract to the four bolded companies, those that were not successful had five days to appeal the decision.  That appeal process can take time, and it should be noted that the state's current mental health managed care contractor (Magellan) won its contract on appeal, after the state originally selected Value Options.  So while the Department of Human Services has made its choice - it will not be final until all appeals are finalized, and contracts are signed.

The evaluation committee made a list of each company's strengths and weaknesses.  You can find the complete list here.  Here are a few of those strengths and weaknesses for the four companies chosen:

  • Amerigroup Iowa
    Strengths: 5.2 million members in 19 states; strong successful implementation experience; good pharmacy management plan; comprehensive approach to behavioral health, long-term supports and services (LTSS), and person-centered planning; high LTSS member satisfaction (greater than 90%); recognition of the importance of social services like housing, employment, and transportation; LTSS incentive programs including nursing facility transition incentives; good electronic access to after-hours care, web-based physician consultants as an alternative for members needing non-emergent care, 24/7 behavioral health consultation, and expanding telehealth; proposing enhanced services to fill the rural gap; goal of using habilitation to achieve outcomes in child welfare, juvenile justice, and education; partnership with Wellmark BlueCross BlueShield in developing relationships with existing providers.

    Weaknesses: Network development focus on physical health; low percentage of members in other states have serious mental illness (SMI) or intellectual and developmental disabilities (IDD).
  • UnitedHealthcare Plan of the River Valley, Inc.
    Strengths: 5.1 million members in 23 states; established network in Iowa; recognize social services are part of members’ needs, including employment; good LTSS experience including success in moving individuals from nursing facilities into the community; discuss providing in-lieu of services for facility transition and diversion; waiver waitlist experience; comprehensive behavioral health approach including 24/7 crisis line; stated support for serving individuals in the most integrated setting; strategies for provider recruitment and work plans that include LTSS, behavioral health, and rural access; solid member and provider satisfaction results; strong demonstrated results of care coordination in other programs.

    Weaknesses: LTSS experience is primarily with elderly; two instances in which they failed terms as part of contract negotiations.
  • Wellcare Health Plans, Inc.
    Strengths: 2.3 million members in 9 states; 8 offices in Iowa - headquarter in Des Moines with 2 regional offices and 5 locations using a welcome room concept with walk-in member services; thoughtful approach to member services; member services help line available 30 days prior to go-live; preferred partnership with UnityPoint including care coordination strategy; strong successful implementation experience; demonstrated an awareness of Iowa-specific health issues and proposed solutions; has begun coordination with regions and other community-based organizations; demonstrated understanding of integrating physical and behavioral health; facility transition success in other states; propose rural solutions including telemedicine and mobile health; incentives for reduction of facilities and hospital use; provide special assistance for LTSS and members that cannot be reached by telephone; community liaisons will be staffed by Ticket to Work and Welfare to Work individuals as much as possible

    Weaknesses: 70% of member services staff located out of state; utilization management and prior authorization strategy lacked comprehensive detail for behavioral health and long term care.

  • AmeriHealth Caritas Iowa, Inc.
    Strengths: Experience in 16 states and DC; headquarters and 3 community wellness centers in Iowa that provide in-person member services;Let Us Know Program for providers to identify need for non-medical services; 24/7 provider assistance line; good description of overall approach to behavioral health services; Iowa specific research regarding LTSS; demonstrates understanding of current community care model; identifies Iowa specific issues and working with stakeholders to resolution; focus on comprehensive LTSS network; multiple opportunities for members, providers, and stakeholders to provide input and advice; address rural strategy including telemedicine and mobile services; care plans are designed for member accessibility and success; good alignment with Healthiest State Initiative and regional mental health/disability services system.

    Weaknesses: Limited description of interface with other state agencies; LTSS primarily emphasizes services for elderly; frequency of level of care reassessment in care coordination; nurse call line may require member call back for resolution; no interim key personnel named and no details on how they intend to fill positions.