As comprehensive healthcare reform fades from the federal agenda, some executives believe governmental efforts to reform the delivery system are also dead. But such thinking overlooks the torrent of state efforts to establish Medicaid managed-care programs.
Six states have obtained waivers from HCFA allowing them to require Medicaid patients to enroll in managed-care programs. Another eight applications are nearing the final approval stage, and HCFA Administrator Bruce Vladeck said about 10 more states are beginning the application process.
Arizona has had a statewide Medicaid managed-care program since 1982, and New York is allowing recipients to choose between fee-for-service medicine and managed care.
Although preliminary evidence indicates such programs can save as much as 20% annually compared with fee-for-service coverage, providers haven't welcomed them with open arms. Some of the loudest complaints-about low reimbursement rates, inept managed-care organizations and interference with patient relationships-have come from physicians protesting Tennessee's TennCare program.
But wise providers recognize Medicaid managed care as an opportunity to provide a more rational system of care to patients they'll otherwise end up treating in more expensive settings. Others see the program as a steady-though inadequate- stream of money that can help them prepare for capitation.
Even though many of Tennessee's 4,600 physicians are grumbling about the program, 75% are participating, one study shows.
To achieve success, providers must work with state officials to link poor patients with primary-care physicians and help keep them out of emergency rooms. Such programs require extensive education and outreach efforts, including health screenings and parent-skills seminars, emergency transportation, chiropractic services, home care and 24-hour patient-information hot lines.
HCFA must also develop adequate methods to assure that enrollees in Medicaid reform programs have adequate access to services and get high-quality treatment.