Medicaid turns to managed care to save money

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Mississippi’s Division of Medicaid needs money now.

Last week, the state agency requested a $75 million deficit appropriation. Then, on Thursday, the governor cut several agency budgets another 1.4 percent. For Medicaid, this amounts to another $14 million dollars.

But finding cuts with this particular state agency is a long game, according to legislators. As a result, a Medicaid hearing on Thursday barely touched on the now $89 million deficit. Instead, representatives from Medicaid and managed care companies promoted long-term cost reducing strategies.

Gil Ford Photography

Sen. Brice Wiggins, R-Pascagoula

“We’re not going to fix this overnight,” said Sen. Brice Wiggins, R-Pascagoula, who chairs the Senate Medicaid Committee and organized Thursday’s meeting. “It’s about managing the (health care) costs as opposed to fixing or eliminating current expenses.”

Wiggins said that the status of Medicaid’s deficit request has not been settled. If it’s not funded, Medicaid has few strategies for immediately eliminating costs because, unlike most state agencies, only three percent of costs are administrative. These strategies, outlined in Mississippi Code, include cutting optional services, such as pharmacy coverage. After this, hospitals and provider payments would be cut.

Zachary Oren Smith, Mississippi Today

Sen. Hob Bryan, D-Amory

“So if the Legislature does not wish to provide an appropriation, we’ll just pay the doctors less and the hospitals less, which I think is appalling,” said Sen. Hob Bryan, D-Amory.

The Division of Medicaid has requested a deficit appropriation every year since 2012 to fill in the gaps. The $75 million appropriation request for 2017 follows that pattern. The Legislature originally appropriated Medicaid $63 million less than it had requested. Then, in September, the governor made the first round of mid-year budget cuts, for a total of $78 million in cuts.

Much of the focus in Thursday’s meeting fell on United Health Care and Magnolia Health, the two managed care providers in Mississippi. Heads of both companies spoke about their efforts to keep clients healthy — and keep them from spending money on expensive services like the emergency room.

Jocelyn Carter, the CEO of United Healthcare, presented her company’s strategies for cost reduction. They run the gamut from providing fresh produce to clients to requiring emergency room patients to follow up with primary care physicians a few days after leaving the hospital.

“We’re looking at the holistic whole person with these programs,” Carter said.

Carter said United Healthcare has a $73 million investment in the state, with nearly 500,000 members.

Mississippi State Medical Association

Dr. Lee Voulters

But other speakers called managed care companies financial drains on the health care industry. Dr. Lee Voulters, president of the Mississippi Medical Association, said providers often spend hours getting approval for tests and physician referrals.

“It’s a tiresome burden, typically, because the vast majority of these cases are approved,” Voulters said.

For Voulters, the future of managed care in Mississippi lies in a nonprofit model sponsored by the Mississippi Hospital Association. MississippiTrue is currently in proposal form, but Voulters said, if approved, it could be ready to offer care by 2018. Physicians and hospitals would opt in and become equity members of the organization.

“If we get physicians involved in the clinical decision making, that’s the best strategy,” Voulters said. “They’re already out there. They know the best way to manage chest pain, the best way to manage diabetes.”

For the time being, however, solutions to Medicaid’s current and future financial issues remain up in the air. Wiggins said that Thursday’s meeting was, more than anything, a jumping off point for more discussions.

“Look, Medicaid is this huge problem,” Bryan said. “And we didn’t really discuss the biggest problem, which is reducing overall health care costs. … If you’re going to talk about Medicare, you have to step back and look at the big picture.”

 

  • Bobby Johnson

    i have friends on united health care…..it seems to be better than magnolia for most…..still they have trouble getting their meds……most need more than the plan will cover…..or the plan won’t approve what the dr. orders……..one friend was given a list from united of meds that could be approved in place of what the dr. ordered…….then when the dr. chose one of them……the plan would not approve that one…….what gives …..we need a better plan…..one where people can get the meds they need and the amount of meds they need……the DEA needs to back off so pain meds can be given to the folks that need a stronger med…..if someone is selling them or buying them from street dealers…..let the DEA do their job and BUST THEM……don’t make us old folks suffer…..because of a few idots trying to make a few bucks……and this is just the beginning of what i have to say……

  • Diana Hinton

    If we had universal health care, this wouldn’t be happening.

  • William H Smith

    Questions about Insurance and Healthcare
    for Conservatives and Liberals

    For Conservatives

    Are you prepared to see people denied healthcare if it means their not having serious illness treated or dying from preventable causes because they lack healthcare?

    If are so prepared:
    Would you also do away with or severely limit the benefits currently provided seniors by Medicare?
    Would you do away with or severely limited the benefits provided to the poor by Medicaid?`
    Do you make any distinction between the sick and the injured in the obligation of hospitals to treat? Would allow hospitals to deny emergency treatment to either or both?
    If the Affordable Care Act is repealed, to what point in American history would you set back the clock with regard insurance and healthcare?
    Do you favor a purely market-driven (to the extent such is possible in the American economy) to the availability of insurance and the distribution of healthcare?
    Would you do anything at all to insure or provide healthcare for those with pre-existing conditions?
    Is there a limit in the numbers of persons or percentage of the population suffering death because of lack of healthcare you would find unacceptable?

    If you are not so prepared:
    What would you be willing to do to assure that persons with serious illnesses are treated and that persons whose deaths are preventable do not die?
    Assuming you would want churches and charitable organizations to enable uninsured persons either to obtain insurance or to receive healthcare, what, if anything, would you do about those for whom these organizations could not or would not provide?
    Would you leave in place Medicare? What changes do you think are necessary for it to continue to be viable?
    Would you leave in place Medicaid? What changes would in terms of contraction, expansion, modification to keep it viable?
    What, if anything would you do about those with pre-existing conditions?
    What, if any role, do you envision for the government?
    Do you think it would be more likely to come up with workable healthcare solutions by working with Conservative Group 1 above or Liberal Group 2 below?

    For Liberals

    Are you prepared to spend an unlimited amount of money so that everyone with a serious illness and everyone with a preventable cause of death is treated?

    If you are so prepared:

    Would there be any role of the insurance industry?
    Do you favor a single payer system of providing healthcare?
    Even, if an unlimited amount of money were provided, would rationing of healthcare be necessary?
    How would you provide the money to insure and/or treat everyone? Increased deficits? Higher taxes for some?
    What, anything would you do to restrain the cost of healthcare? Would hospitals be run by the government? Would doctors become employees of the government? Would the pharmaceutical companies be owned by the government?
    How do you see money being available for medical research that would lead to such things as innovation in treatment, development of new drugs, etc?
    Would parts of the federal budget have to be eliminated, cut, or restrained in order to have money to spend on healthcare? If so, what parts?
    When you say you are willing to spend an unlimited amount of money, do you mean an absolutely unlimited amount of money? Would there be any limits in terms of such things as percentage of the federal/state budgets or percentage of the GDP?

    If you are not so prepared:

    Would you cover with insurance or by some other means provide healthcare for all?
    Do you favor a single payer system or a system that uses some combination of government and private involvement?
    What limits would you impose on expenditures for healthcare?
    What changes, if any, would you make to Medicare and Medicaid?
    Do you think it would be more likely to come up with workable healthcare solutions by working with Liberal Group 1 above or Conservative Group 2 further above?