Task Force Hears Testimony on Managed Care Trends

The Missouri Task Force for Examining Statewide Medicaid Delivery Models held its second hearing on December 1 in Jefferson City. This task force, which is comprised of legislators and health professionals, was created to develop a strategy for implementing a statewide model of healthcare delivery. Once the task force has finished conducting hearings, it will present recommendations to the General Assembly.

At the December 1 hearing, the task force heard testimony from Justin Senior, Medicaid Director at Florida’s Agency for Health Care Administration, and Dr. Vernon Smith of Health Management Associates.

Senior discussed Florida’s transition to statewide managed care and outlined several provisions of the state's model that he believes made the program more successful.

To encourage managed care companies to bid in Florida’s rural panhandle, plans that won that region were able to take their pick of another market. Plans that leave one region lose all contracts in the state. The state also set very high network adequacy requirements so that plans would be able to absorb more patients if a managed care company pulled out of a region.

In order to improve patients’ experiences with MCOs, Florida created a centralized complaint hub. This allows the department to identify trends and address widespread problems. The state also publishes report cards that grade MCOs based on HEDIS scores. Patients can then view these scores when selecting a plan.

The state does not set any standards for what or how managed care companies pay providers. Senior said the under the managed care program some providers are paid more while others are receiving lower rates.

Dr. Smith from Health Management Associates spoke on national trends in managed care administration. One important trend in Medicaid, and the healthcare sector as a whole, is an increased emphasis on accountability and quality measures. States’ strategies for holding plans accountable for improved patient health include: withholding percentages of payments until benchmarks are met, financial bonuses or penalties based on performance, and publically reported outcome measures.

States are also seeking broader payment and delivery reforms that will improve care while addressing rising healthcare costs. An emphasis on more coordinated care has increased interest in patient-centered medical homes, accountable care organizations, episode of care payments, and delivery system reform.

The next task force meeting is scheduled for Wednesday, December 16. Dr. Joe Parks, Director of Mo HealthNet, will present to the task force.