Managed Care Organizations Unite to Expand Access to Care for New Mexicans
By:
Brandon Fryar, president, Presbyterian Health Plan
Carolyn Ingram, president, Molina Healthcare New Mexico
Andrew Peterson, CEO, UnitedHealthcare Community Plan of New Mexico
Janice Torrez, president, Blue Cross and Blue Shield of New Mexico

In our state, managed care organizations (MCOs) safeguard access to critical and comprehensive health care services for nearly one in two New Mexicans. Under the Medicaid Turquoise Care program, it is our responsibility and privilege to ensure that New Mexicans access high-quality care and achieve positive health outcomes.

The majority of state Medicaid programs use a managed care model for its proven ability to improve health outcomes and focus on the unique needs of individuals and communities. The managed care model offers members care coordination, a robust provider network, and expanded access to care in historically underserved areas through innovative partnerships and programs.

We take our responsibility as MCOs seriously and work to improve access to both physical and behavioral care while addressing social determinants of health such as housing and food insecurity. MCOs use data to identify risks, conduct member outreach, create integrated care plans and provide digital tools to help members manage their care.

We continually grow our provider network year-over-year, including our behavioral health network. We help behavioral health providers with billing and claims processes, training and education opportunities, and sharing data about improving the health of their patients.

MCOs are making significant strides to expand access along with our community providers and partners, including:

• Partnering with providers to expand inpatient and outpatient behavioral health services, funding new school-based health centers, supporting projects like New Mexico Access to Behavioral Health for Children, and bringing national providers to our state to close gaps in care. This includes the development of outpatient programs and residential treatment centers with the goal of reducing out-of-state placement of residents. We are also working with behavioral health providers to expand telehealth capabilities which improves access for people living in rural communities.
• Supporting innovative care models. MCOs are supporting Certified Community Behavioral Health Clinics (CCBHCs) throughout the state, which provide integrated, evidence-based substance use disorder and mental health services, including 24/7 crisis response and medication-assisted treatment. 
• Investing in the recruitment and retention of health care workers. MCOs collaborate with providers, academic institutions, and community-based organizations. This includes increasing the number of community health workers and partnering with the New Mexico Primary Care Association to support Federally Qualified Health Centers’ staffing.
• Improving maternal health outcomes. MCOs collaborate with organizations like the New Mexico Perinatal Collaborative, New Mexico Doula Association and Navajo Breastfeeding Coalition to support more equitable access to maternal care.
• Addressing the social determinants of health. Working with community organizations like Meals on Wheels and ABQ Faithworks, MCOs are investing in programs that connect members to local food and housing resources.
• Reimbursing providers based on the care provided and the needs of the community. Managed care can pay providers based on members’ health outcomes and through rates that reflect their unique needs. For certain provider types, especially in rural communities, MCOs have the flexibility to enhance pay for specific services.

For children in state custody (CISC), Presbyterian Health Plan, the MCO for the CISC program, is growing the infrastructure to support this vulnerable population in accessing trauma-informed, evidence-based care.

Addressing the challenge of expanding access to care is one that requires high accountability. The New Mexico Health Care Authority (HCA) leads the nation in Medicaid fiscal oversight and contract performance requirements – especially in network development, monitoring quality and access to care. MCO performance is audited through multiple third-party reviews.

While we have more work to do, through shared vision, increased innovation and strong accountability, we will continue to increase access to care for every New Mexican we serve.