Scott Markovich is on the hunt for Medicaid savings

HARTFORD, Conn. - With many state Medicaid programs facing increased enrollment but decreased budgets, the timing of CareCentrix's recent expansion into the Medicaid managed care market couldn't be better, says Scott Markovich.

“The largest pot of money is Medicaid for most governors,” said Markovich, the company's new general manager of Medicaid. “We are going to see a shifting of funds, as more people tax the system. They will transfer the risk to health plans and that's where an opportunity with us comes into play.”

Markovich, who has worked in Medicaid managed care on the health plan side for 24 years, spoke with HME News recently about how the current COVID-19 pandemic has propelled CareCentrix's move toward Medicaid.

HME News: What is your primary focus in your new role?

Scott Markovich: We are working on business planning to look at the total cost of care of individuals focused on those in the aged, blind and disabled category, and looking at those that receive managed long-term care services. Managing members at home with the right support—whether it be home care, DME or other community based support—and looking at the total cost of care of members and really trying to avoid the skilled nursing facilities or hospital visits, is what we are going to be focused on.

HME: How do you balance reducing health plan costs without compromising patient care and provider reimbursement?

Markovich: With Medicaid, there are fee schedule floors and ceilings. There are limits set on how low you can go. For us, it's more about utilization and making sure the member is receiving the right services than trying to nickel and dime reimbursement. Diapers and wipes are cheap, but when someone is receiving a ton of them and they don't need them, it does add up.

HME: How has the pandemic impacted CareCentrix's expansion into Medicaid?

Markovich: With COVID there is a demand for this, as more members become eligible as the unemployment rate goes up. As we've seen this unfold, if individuals end up in a nursing home, that's not a good thing. The state will pay for certain members to receive services at home. The more members we can keep at home and the more we can pay for at home, the more the cost savings will be there.