Alaska is launching a kinder, gentler version of managed care for Medicaid recipients.
Unlike other state managed-care programs, which steer Medicaid recipients into restricted networks, Alaska will begin in April two voluntary one-year pilot programs, in four areas of the state, that aim to gradually change recipients' behavior.
The pilots were mandated by a law the state Legislature passed last spring.
The first pilot will run in three areas with a mix of urban and remote locations: Kenai Peninsula, the Matanuska-Susitna Valley and Fairbanks.
The pilot will establish a 24-hour, 365-day-per-year telephone triage system in which Medicaid recipients can call a toll-free number and get immediate access to a registered nurse.
The nurse "will provide them with medical information for whatever presenting clinical concern they have, based on tested clinical protocols," said Palmyra Santos, managed-care specialist with the state's Division of Medical Assistance in Anchorage.
The nurses will also be able to notify emergency rooms and providers if patients so desire, and "there will be a capacity to follow up, call the patient back in an hour and a half, say, to ask if the fever is still high," she said.
"If the patient doesn't have a primary-care provider, we will give them a list of a few to choose from that are accepting Medi-caid patients," she said.
"This is a voluntary
-not a pre-authorization-program," Santos stressed.
The pilot arose from a Medicaid division analysis that found many mothers and children using the emergency room for treatment of common ailments like earaches and colds.
The analysis also found that many recipients do not have a primary-care doctor. "The issue is to get them the right information and hook them into a primary-care network," Santos said.
The second pilot will target clinically complex patients in Anchorage who need medical-care coordination. For example, the program would help a patient who has had cancer surgery and needs follow-up intravenous therapy.
Doctors and hospital discharge planners will refer patients to case managers, who will approach the patient and family and offer services "to help navigate the system, (providing) a bridge between the healthcare system and the home," Santos said.
"We interviewed discharge planners at all the hospitals. They were concerned about the rate of rehospitalization because things are not in place to support (patients) at home," she said.
The voluntary nature of these programs imparts a "completely different flavor, and we think it will get us more participation. It's more of a behavior-shaping model, which can have a lot of positive results," Santos said.
Officials are "not at all talking about restricting networks" in managed care, she said. "We don't see that happening in the near future because of the uniqueness of the state," with its complex delivery system, limited road system and many one-provider towns.
Requests for proposals will be out by the end of December so vendors can bid on the programs in January. The goal is to have the programs operating by April.
Medicaid costs in the state grew to $296 million in 1995 from $200 million in 1992. Between 1992 and 1995, Medi-caid costs per recipient grew by 19%, to $4,243 from $3,558. The number of recipients grew 24%, to 69,739 from 56,380, Santos said.