Michael Monson is the vice president of long-term care and dual eligibles at Centene Corporation. Based in St. Louis, MO, Centene provides programs and related services to underinsured and uninsured individuals, many of whom receive benefits provided under Medicaid. The company operates local health plans and offers a range of health insurance solutions. Michael provides corporate leadership for Centene’s Medicaid managed long-term care products and its Medicare-Medicaid plans. He serves on NQF’s Measure Applications Partnership (MAP) Dual Eligible Beneficiaries Workgroup.
NQF: How has Medicaid impacted the health and healthcare of children and other vulnerable populations?
MM: Medicaid has grown from a modest expansion of state welfare programs 50 years ago to become the nation’s largest health insurer, providing coverage and access to healthcare services for more than 70 million Americans. Many of the individuals Medicaid covers, including low-income adults and children, people under 65 with disabilities, and low-income elderly adults, face complex medical and social needs, and Medicaid offers a broad range of services, including long-term services and supports, with limited or no cost-sharing for beneficiaries.
NQF: Like Medicare, Medicaid is a national program. But it has a very flexible structure to meet states’ specific needs. Can you talk about balancing the challenges and opportunities that result with respect to quality improvement efforts?
MM: Healthcare needs can vary from state to state and even from community to community. The flexible structure of the Medicaid program allows communities to experiment and innovate to address different needs. But quality is a focus of Medicaid across the nation, so when an approach—such as that of the medical home—works to improve patients’ care and health, there’s opportunity for broader adoption.
At the same time, these variations in approaches to measuring quality create challenges with respect to being able to compare outcomes across broader populations. The work that NQF is doing through the Measure Applications Partnership (MAP) provides opportunities to identify best-in-class measures for the adult and child Medicaid programs. MAP also helps the U.S. Department of Health and Human Services look at improving care for dual-eligible beneficiaries by updating and providing the best available family of measures for their care. I’m really excited to be a part of the MAP duals workgroup as it begins its newest project.
NQF: How has Centene approached quality improvement for its Medicaid plans?
MM: Our Integrated Care Management model is at the heart of our quality efforts for our Medicaid managed care and long-term services and supports populations. Each member is assigned a case manager, who is the member’s main point of contact and focuses on individual needs, whether social, behavioral, and/or medical.
We’re always working on new interventions. One example: We’re working to leverage the knowledge of personal care workers in the home to help identify changes in members’ conditions, so that we can more quickly intervene to improve our community’s health, one person at a time.