Just the Facts
As a statewide leader in managed care, Superior HealthPlan wants to make sure you know the facts about the important programs we offer. Click on the questions below to learn about the role managed care organizations (MCOs) have in providing healthcare to people in Texas.
Superior HealthPlan is a managed care organization (MCO) that provides healthcare services to more than 1.2 million members. These services include medical, dental, vision, pharmacy and behavioral health. Having started in El Paso in 1999, Superior now serves members in all 254 counties in Texas.
Most of Superior’s members get healthcare through government-sponsored programs. Superior works with the State of Texas Health and Human Services Commission (HHSC) to bring members benefits in the STAR (Medicaid), Children’s Health Insurance Program (CHIP), CHIP Perinatal Care, STAR+PLUS and STAR Kids programs. Superior has also been the only provider of the STAR Health program, providing coverage to children and youth in foster care since 2008.
MCO contracts for all Medicaid programs are awarded through a competitive Request for Proposal (RFP) process. This allows all MCOs to bid for contracts based on region and program. All contracts have an initial 3-year term and additional one-year extensions. History shows the Texas Health and Human Services Commission (HHSC) normally uses the extensions to the maximum extent to reduce change for members. This is only done when MCOs are performing well under their contract terms.
With about one million Medicaid members in Texas, Superior gets state and federal funding to provide healthcare to each one of them. More than 87 percent of all funds go to medical and pharmacy benefits for these members. Below is a look at how each dollar is spent across all Medicaid programs in Texas.
Title: The Managed Care Dollar at Work
- 20.8 cents is spent on ER & Hospital Costs (ER, Outpatient, Inpatient)*
- 13.5 cents is spent on Prescription Drug Costs*
- 11.8 cents is spent on Physician Service Costs (Primary Care, Specialists)*
- 24.8 cents is spent on Nursing Home & Long-Term Care Services (Service Coordination)*
- 16.2 cents is spent on Other Medical Services (Dental, Physical Therapy, Dialysis, Behavioral Health)*
- *In total, 87.1 cents of every dollar is spent on medical and pharmacy benefits.
- 7.2 cents is spent on Administrative Costs
- 3.1 cents is spent on Premium Taxes & Assessments
- 2.4 cents is spent on Profit (Pre-Tax)
- 0.2 cents is spent on Profit Sharing To State (Experience Rebate)
Source: SFY 2016 -334 Day FSR Filings, Texas Health and Human Services Commission (HHSC) *Income (Pre-Tax) - Not adjusted for all MCO incurred expenses including capital investments and value added services. **Administrative costs are expenses related to managing benefits and payments and coordinating care, including managing the provider network, customer service & creating patient care plans, IT and patient database maintenance, fraud & abuse detections and timely payment processing.
Superior HealthPlan and the State of Texas measure member satisfaction in many ways. As shown below, Superior consistently earns high marks in member satisfaction:
- For a third straight year, Superior is among the top-rated Medicaid plans in Texas, earning a score of 3.5 on a 5.0 scale on the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2018-2019.
- Superior’s Medicare-Medicaid Plan is rated No. 5 nationally for member satisfaction. This is according to the 2017 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is distributed by the Centers of Medicare and Medicaid Services (CMS).
- Superior has a high rate of members choosing to enroll with our health plan. Nearly half (48%) of new members choose Superior. This is based on the most recent data from HHSC.
- Superior has less than one complaint per year for every thousand members in each program. For STAR Health (foster care), Superior received fewer than 60 complaints about accessibility, availability or quality of service last year. That’s out of more than 14 million services provided in 2017.
- 86% of Medicaid recipients say they are satisfied with the care they receive. This is according to a June 2018 survey from the Texas Association of Health Plans.
Financial data for Superior and all other MCOs are available on the Texas Health and Human Services Commission (HHSC) website. Managed care organizations that participate in Texas’ Medicaid programs have to abide by thorough financial accounting and audit standards set by HHSC and the Department of Insurance. These include:
- Financial reports accounting for all MCO expenses are submitted to HHSC quarterly. These are audited each year by external accountants hired by HHSC. These are done to make sure all MCOs consistently comply with accounting standards and regulations.
- Financial audits every 3 years from the Texas Department of Insurance.
- Audits from the State Auditor’s Office and Office of Inspector General for areas of financial impact.
- Contractual limits to profit that Medicaid MCOs are allowed to make.
- No limit on the amount of dollars an MCO can lose if medical costs increase during a financial period.
- Contract guidelines for what MCOs can count in their expenses. This means anything that is not defined by these rules is not paid for by HHSC.
Annual financial audits by an external accounting firm. Conducted to provide confirmation of financial records accuracy and compliance with all standards and regulations to Superior’s Board of Directors.
Superior has the largest provider network of all MCOs. Below is information about the providers that care for our members each day:
- Superior’s provider network for all Medicaid programs includes 69,700 providers across all 254 counties throughout Texas. Currently, 91% are open to see new patients.
- In a 2017 survey conducted by Superior, providers said their satisfaction with the plan exceeded the 75th national percentile industry benchmark for the following: overall satisfaction, utilization and quality management and network/coordination of care measures.
- More than 86% of providers would recommend Superior to their peers.
Superior was awarded the first STAR Health contract with a start date of April 1, 2008. This was based on participation in a competitive bid process. Superior has been the only provider since. The company earned the contract again in 2015 based on rigorous standards in a competitive process. According to Medicaid/CHIP in Perspective, 11th Edition, STAR Health “is designed to better coordinate the health care of children in foster care and kinship care through one statewide MCO.”
Superior has demonstrated continued high performance in customer satisfaction and quality requirements for children and youth in STAR Health. Superior also drives innovation and improvements across many facets of the STAR Health program:
- From 2015 through 2017, 14% fewer children and youth in foster care accessed the Emergency Room for non-emergent reasons.
- Children between the ages of 3 and 19 exceeded the 90th national quality percentile in getting well-child visits.
- Children between the ages of 12 months to 6 years exceeded the 90th national quality percentile in access to healthcare services.
- Superior’s Psychotropic Medication Utilization Review program has reduced the rate children in foster care who are prescribed potentially dangerous (and addictive) psychotropic drugs by more than 41%; from 25% in 2007 to 14.6% in 2017.
- Superior’s Turning Point program, a psychiatric hospital diversion program for children and youth in foster care, has lowered the 90-day readmission rate for psychiatric hospitalizations to 12% for children and youth in the program. This is compared to 38% for youth who go to an inpatient facility instead.
With more than 1.2 million members, Superior puts members first. Here are just a few of their stories:
Rob Casias’ commitment to family began with his mother. This video explores their relationship and how Superior has been there along the way.
Cori Melanson relies heavily on a Superior employee. In more ways than one, their relationship depends on words, but this story is best told through film.
Kate’s daughter has a rare skin condition, affecting her life in a major way. This video examines how far unwavering care and support can truly go.
To better serve children in foster care, Superior has identified centers of excellence. This video looks at one of these essential resources in Houston.