Samantha Olds Frey, CEO of the Illinois Association of Medicaid Health Plans for a decade, highlights the pivotal shift towards building trust between providers and managed care plans in Illinois. She emphasizes the growing recognition of addressing health-related social needs within Medicaid nationally. Illinois is actively engaged in redetermination processes and focuses on maintaining eligibility while eliminating administrative barriers. She acknowledges challenges like reimbursement rates but emphasizes streamlining administrative processes to preserve provider relationships. Ms. Olds Frey envisions the next decade as one of innovation, promoting value-based contracting and improved outcomes in Medicaid.
In her decade-long tenure as the CEO of the Illinois Association of Medicaid Health Plans, Samantha Olds Frey has dedicated herself to establishing a strong foundation of trust with healthcare providers. She has tirelessly worked to nurture this trust, which has been an essential element in the development of managed care in Illinois. Ms. Olds Frey leads an association representing six managed care plans, including Humana, Aetna, and BCBS of Illinois, responsible for managing Medicaid care for the state’s 3.9 million members. In a recent interview with Becker’s, she shared insights into the current state of Medicaid in Illinois and her vision for its future. The following responses have been summarized and edited for brevity and clarity.
Question: You’ve reached a significant milestone of 10 years at the helm of the Illinois Association of Medicaid Health Plans. What stands out as the most significant change you’ve witnessed during this time?
Samantha Olds Frey: It’s challenging to pinpoint just one change, but if I had to choose, I’d emphasize the transformation in the collaboration between healthcare providers and managed care plans in Illinois. Our state was relatively late in adopting Medicaid managed care, with significant changes occurring only about a decade ago. The introduction of care coordination programs fundamentally altered the healthcare system in our state, but building trust within these new relationships was an arduous and time-consuming process.
Taking a broader perspective beyond Illinois, we’ve also seen a nationwide shift towards recognizing and addressing health-related social needs within the Medicaid program. While it was always understood that factors like housing, food insecurity, transportation, and employment influenced healthcare outcomes, there was often a belief that Medicaid did not cover these areas. However, the conversation has evolved to explore how Medicaid can play a role in addressing these social determinants of health, which is a welcome change.
Question: Medicaid redeterminations are a pressing concern for leaders across the country. What is the situation in Illinois, and how is your organization contributing to this effort?
Samantha Olds Frey: Illinois is fortunate in its commitment to getting redeterminations right. Our state is focused on maintaining eligibility for those who qualify for Medicaid while ensuring a seamless transition for those who no longer meet the eligibility criteria. We maintain ongoing communication with the state, exchanging questions, ideas, and best practices.
Regarding our efforts, it’s easier to list what we aren’t doing because we are exploring a wide range of strategies. We collaborate with community-based organizations, such as food pantries and homeless shelters, and engage with providers who regularly serve our members. We employ various communication methods, including texting, emailing, calling, mailing, door-knocking, and social media advertising. We are open to new ideas and approaches to ensure that individuals do not lose coverage due to administrative challenges.
Question: Some providers are choosing to part ways with Medicaid managed care plans. Do you have any recommendations for preserving these crucial relationships?
Samantha Olds Frey: There are certain challenges that we cannot fully address, such as Medicaid reimbursement rates, which can be a significant hurdle. However, we can make progress by addressing bureaucratic and administrative processes that frustrate providers. In Illinois, we have successfully standardized certain procedures, like roster templates, across all health plans, making it easier for providers while ensuring better information for the plans.
Question: What are your hopes for the future of Medicaid 10 years from now?
Samantha Olds Frey: I’d like to think that the first 10 years were primarily about establishing trust and partnership between providers and plans, addressing fundamental challenges related to billing rules, claims processing, and responsiveness. We’ve made significant strides in building this trust in Illinois, even through setbacks and progress.
Looking ahead, I hope the next phase involves innovation. There’s a reason we moved away from a fee-for-service system. We need to earnestly implement value-based contracting within the Medicaid program, linking provider reimbursements to the quality of outcomes achieved. We must encourage progress in challenging clinical areas and provide support to healthcare providers in their efforts. My aspiration is that for the next decade, our focus will be on collectively transforming the system to better serve the needs of Medicaid members and enhance overall outcomes.
