TALLAHASSEE, Fla. (AP) _ Florida's experimental, five-county Medicaid managed care program is providing such poor service that the state should suspend plans for expanding it statewide, according to a report released Monday by a liberal-leaning think tank.
A spokeswoman for the state agency that oversees Medicaid responded in an email that the report “provides an incomplete and inaccurate picture with respect to access.''
Managed care is provided mostly by private companies including health maintenance organizations that are paid a certain amount for participants regardless of how much service they use.
Supporters say it will cut costs compared to the conventional fee-for-service plans that pay according to how much service each patient uses. Critics argue that managed care reduces the quality of care because providers can make more money if they cut services.
The Tallahassee-based Florida Center for Fiscal and Economic Policy notes in the report that it relied on claims information because the state has not yet made “patient encounter'' data available although the experimental program began five years ago.
There's a problem, though, with using data on claims rather than visits, wrote Michelle Dahnke, a spokeswoman for the Agency for Health Care Administration.
“Multiple claims can be reported by visit,'' Dahnke wrote. “Numbers of claims does not provide information about access to service.''
She wrote that primary care is commonly provided through managed care plans by paying a fixed amount per participant each month, making it inappropriate to use paid claims as a measure of access to care.
The report says the claims information shows a wide variation in primary care utilization rates among various managed care plans available to Medicaid participants.
The rate for one plan was only 46.8 services per 100 enrollees compared to 439.5 for another in the 2008-09 budget year. Likewise in the next year one plan had a utilization rate of just 44.1 services per 100 enrollees while another had 395.1.
“Reasonable variation in primary care utilization is to be expected,'' the report says. “However, the magnitude of the differences among plan access rates is so pronounced as to preclude the possibility they can be explained as reasonable variation.'
Another finding was that access to primary care in the five participating counties was “significantly worse'' than before the pilot program began and in the case of some plans “alarmingly worse.''
The five counties are Broward in South Florida and Duval, Baker, Clay and Nassau in the Jacksonville area.
Primary care access did improve over time but “remained disturbingly low'' in the five counties, the report says.
The Republican-controlled Legislature last year passed a pair of laws that would phase-in managed care statewide but it is contingent upon receiving a waiver from the federal government, which has not yet made a decision.