Tuesday, May 13, 2014

MMCC Podcast Series with Cindy Pigg of Magellan Medicaid Administration

Welcome to IIR’s Healthcare Podcast Series. Today we have Cindy Pigg, Senior Vice President of Pharmacy with Magellan Medicaid Administration. Click here to download the complete podcast. And make sure you join us at the 22nd Annual Medicaid Managed Care Congress taking place May 19-21 in Baltimore.

What are the unique challenges faced by states in Medicaid Managed Care Organizations? 

Cindy: Significant challenges and quite unique. Number one, how do you engage this population in managing their healthcare? We talked a little bit about this already, but we’ve got unique patient characteristics – the prevalence of mental health, the health literacy, the difficulty navigating the system, the cultural sensitivities. So, we’ve got opportunities to figure out how to engage this population. 

The challenge in managing their pharmaceutical care is that in this population, we lack two tools that are critical that we use on the commercial side that just don’t exist in the Medicaid space. Those being co-pays at a level that are significant enough to change behavior and mail order pharmacy – the home delivery pharmacies where we do a lot of utilization management using the pharmacists that are working in dispensing their mail order prescriptions. So, we’ve got to figure out that challenge of how to engage consumers with different tools unlike what we’ve used in the commercial market. 

I think a challenge that the states and the Medicaid Managed Care Organizations are going to face is really predicting the costs. There are so many unknowns. What is this patient population’s pent up demand that we talked about? What is the impact of specialty pharmaceuticals going to be in this population? I think the predictive modeling and the analytics to assist states in Medicaid Managed Care Organizations is an essential skill set that is going to be needed as we navigate these new waters. 

We talked about the access issue. There is going to be no access issue with pharmacies because you have probably have seen this in the press. There are actually more pharmacies than there are McDonald’s or Starbucks. If you just think about it, if you are looking at a pharmacy on this corner, there is probably a pharmacy on the other corner. So, access to pharmacies is not an issue, but access to physicians that we talked about is another unique challenge. 

Then we are seeing in the press every day now issues with Medicaid reimbursement. So, even if we did have enough primary care physicians, the payment mechanisms for Medicaid, I think, is a challenge that will be unique state-by-state in Managed Medicaid Organizations. 

I’d summarize this question by saying that the standardized PBM model just won’t work. These patients are unique. We talked about the challenges, but this need for a customized Medicaid strategy to deal with these unique needs is going to be absolutely essential to help the states and the Medicaid MCOs navigate these challenging waters for this Medicaid and subsidized exchange population. 

To hear more about this topic and many more, please join us at the 22nd Annual Medicaid Managed Care Congress, May 19-21 in Baltimore, MD. 

To save 15% off your registration rate, use the code: XP1926BLOG - Register Now!

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