This year, Florida will instate a complete modernization of Medicaid. Since Broward County is one of two counties selected to pilot the program, the reform is certain to bring many changes to South Floridas health industry.
Currently, almost a quarter of the states budget is allocated for Medicaid. Forecasts indicate that by 2013, about 60 percent of the state budget would be needed in order to adequately run the current Medicaid system. Clearly, there is a need for change. For this reason, Florida legislators constructed a plan to modernize the Medicaid program. The new program will be implemented in Broward and Duval counties in July 2006. The reform calls for Medicaid participants to be enrolled in managed-care programs or other plans such as provider-sponsored networks, specialty networks or physicians networks. Since the North Broward Hospital District has operated its own coordinated care programs for some time, the district has worked with and supported the state in its development of comprehensive legislation for Medicaid reform.
“We thought the Medicaid reform was a good thing for the state and that its heading us in the right direction,” said Charlotte Mather, Vice President of Government Relations for NBHD. “In our experience, we have found that working with our patients in a comprehensive, coordinated fashion actually helps them manage their health better with improved health outcomes, and at a lower cost to the system.”
One benefit to the managed-care aspect of the reform is the ability of patients to have more control of their care. Under the current program, there may not be a lot of cohesiveness in a patients care because different physicians will diagnose a patient separately. But under the reform, patients will have someone to oversee the overall treatment they will receive.
However, there is some risk in implementing a system in which Medicaid patients enroll in managed-care programs.
Dr. Arthur Palamara, Chairman of the Legislative Committee for the Broward County Medical Association and a vascular surgeon, believes the new plan puts vulnerable people in a complex system. Many times, these patients are unable to make the best choices for themselves, and may not fully understand the options available.
He adds that eventually, these patients will likely turn to the emergency room for medical care because its a much simpler option.
“We all strive for simplicity whether we know it or not,” Dr. Palamara said. “When we have simplicity offered in the emergency room, people tend to gravitate towards that.”
Although an increased number of plan providers and benefit packages may be confusing to some, there is still another benefit, according to Tom Summerill, Chief Executive Officer of UnitedHealthcare AmeriChoice Florida.
Summerill, who heads the Medicaid branch of UnitedHealthcare in the state, points out that this increase will promote competition, which will encourage plan providers to manage plans well and provide the best services available. As for the wealth of choices, Summerill sees it as the industrys responsibility to ensure that their customers are educated about their options and understand all available choices.
Risk-adjusted rates will be another new aspect of Medicaid. Typically, Medicaid patients who suffer more serious conditions have more difficulties finding adequate care. By allocating more funds for these patients, more providers will be better able to help those who need more specific services.
“With risk-adjusted benefits, the plans are compensated appropriately and can provide the appropriate amount of services to the person.” Mather said.
From a business standpoint, plan providers now have a way to make a profit where before they were unable (or in some cases hesitant) to do so.
“Rather than shy away from sicker people, now theres a reason to create an environment to bring people with more serious diseases, provided that you are good at taking care of them.” Summerill said.
A main concern on everyones mind will be compensation to healthcare providers.
As Dr. Palamara points out, “Were the ones who take care of the sick people, and at some point in time, were going to demand to be paid.”
Knowing that adequate physician compensation is a typical problem in Medicaid, Dr. Palamara and other Broward physicians are forming a provider-sponsored network that they hope will help rectify this problem.
“What we doctors would like to try to do is at least have some sort of a role in determining how this money is spent and how the patients receive care.” Dr. Palamara said.
There are still many aspects that are yet to be fully established.
“One of the most important things is making sure the details are ironed out in a way thats good for the recipients and good for the providers so that the providers can continue to offer good care and the recipients can get all the services that they need and deserve,” Mather said.
Ultimately, success of Medicaid reform rests on all parties involved legislators, healthcare providers, physicians, and insurance providers.
“Change can always be bad if its executed poorly,” Summerill said “But if its done well and done right, I think the new Medicaid reform is a very appropriate thing to do.”