Across the country, nearly 75% of people who are enrolled in health insurance coverage through Medicaid are part of a managed care system. In such arrangements, states contract with private health insurance companies. Medicaid enrollees then choose or are assigned to one of the plans offered, which are predominately Health Maintenance Organizations (HMOs). The state pays these HMOs a set amount for managing each enrollee’s healthcare.
In Florida, nearly all Medicaid enrollees are part of a managed care plan. In 2014, the legislature required that the state transition to a managed care system in an effort to reduce costs to the state, and improve access to and quality of care to Medicaid enrollees.
Many wonder now, did this transition accomplish these goals? The Florida Health Alliance and the Tampa Bay Healthcare Collaborative (TBHC) hosted a roundtable discussion to ask local healthcare provides, insurers, policy experts and advocates to discuss their experiences with Florida’s statewide Medicaid managed care system.
Stakeholders identified opportunities for strengthening Medicaid managed care in three areas: access to care, quality of care and affordability. Here’s what attendees had to say.
Access
There is opportunity to coordinate with community partners to increase awareness of resources and enhance health literacy. Many enrollees often have difficulty managing the complex managed care system and understanding the medical or insurance information that is given to them.
Participants discussed how this problem has been noted in previous research. A recent report from the Georgetown Center for Children and Families found that some Medicaid managed care plan requirements (specifically related to prior authorization) prevented children from receiving treatments or drugs recommended for them. Similarly, the report found that it is especially difficult for children to receive care from a specialist. Fifty-nine percent (59%) of Florida pediatricians who participated in a small survey conducted by the report’s authors said that referring their patients to specialists was problematic.
Quality
Stakeholders reported that it’s often difficult to have clear communication between the state, who administers the Medicaid managed care program, the insurers, who pay for the program, and the providers who care for patients who are covered by Medicaid. Stakeholders recommended establishing a system to strengthen communication, along with increasing data sharing and transparency, to help to enhance the quality of the service provided to Medicaid enrollees.
Affordability
Many issues related to affordability center around the cost of prescription drugs (in an earlier blog post, TBHC explored some of the reasons for the increasing cost of prescription drugs). Stakeholders recommended that one way to improve affordability is to permit health plans to negotiate with prescription drug companies.
The feedback obtained will be incorporated in the Florida Health Alliance’s upcoming advocacy work in an effort to strengthen our statewide Medicaid managed care system.
Managed care will continue to expand within the Medicaid program. While this provides opportunity to control costs, managed care arrangements are extremely complex, and can make it challenging to ensure that enrollees receive a high quality insurance product that provides access to the services they need.
As a result, it will be increasingly important for community stakeholders to work together with state agencies, insurers and providers to adopt creative solutions that can improve access and quality, while at the same time controlling costs.
For more information, or to get involved in this conversation in Florida, visit the Florida Health Alliance website.
