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Mis-managed Care

by: RxChoiceandAccess

Wed Nov 07, 2012 at 04:24 PM CST

Managed care systems for Americans on Medicaid, when executed incorrectly, don't benefit anyone. And considering the level of mismanagement taking place in some states, others, including Texas, should seriously reconsider implementing managed care for Medicaid patients.

Take what's happening in Kansas. One managed-care company, Passport, has filed a formal complaint because the state miscalculated the amount of patients the company would receive under the new program, dropping it from 41 percent down to 27 percent. As a result, Passport is formally complaining that the state has violated its own bidding process.

On top of that, Passport claims that if the state were to assign them an even larger share, an astonishing 80 percent of the region's population, the state would save an estimated $80 million.

Instead of focusing on providing quality health care for patients, Kansas and its managed care companies are fighting each other over who gets assigned the largest patient load. This simply will not work.

Texas needs Medicaid reform that makes sense, and helps patients. Visit Pharmacy Choice and Access Now to find out more.


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Mis-managed Care | 1 comments
KY, not KS (0.00 / 0)
Passport is unhappy they are no longer being the only game in town. The state recently completed a procurement and made awards to some new players in the market they previously controlled. Disagreement between an awardee and the state over the assignment formula is not mismanagement.

I don't think you can cite 'the level of mismanagement in some states' without providing more support than this example (which IMO is not mismanagement). Certainly, managed care is not a panacea. It is simply a tool, and some states use it more effectively than others. States use it for budget certainty, and I don't think anyone can argue that there isn't more attention paid to quality and access under Medicaid managed care than Medicaid FFS. Where I think some states fall short is in the level of sophistication of their oversight, and using all the information they require contracted plans to provide for program improvement. But there is so much more accountability with managed care, and so much more information available to the state and the public on performance, that there historically with FFS.

Mis-managed Care | 1 comments
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