The jury is still out on whether managed care companies can provide quality care and cost savings, reported Kaiser Health News and the St. Louis Dispatch.
On one side of the debate, St. Louis-based Centene Corporation cites its contract to manage healthcare for 30,000 foster children in Texas. Within a year, the state budget for foster children dropped along with the number of psychotropic drug prescriptions.
Despite Centene's success, health policy experts still have doubts about expanding Medicaid managed care to achieve significant cost savings.
"The Medicaid managed care population is largely women and children, and they're healthier and less costly than the older patients with multiple, chronic conditions like diabetes, heart disease and cancer," Karen Edison, M.D., director of the Center for Health Policy at the University of Missouri, told KHN. "It's hard to imagine that you can translate the cost savings seen from managed care of women and children to the sickest Medicaid patients," she said.
Adding to the dispute, managed care companies have yet to recruit enough physicians willing to accept Medicaid reimbursement rates, said F. Scott McCowan, a clinical professor at University of Texas School of Law and director of the Children's Rights Clinic, KHN reported.
Despite quality care and cost-saving concerns, more states are moving traditional nursing home residents into Medicaid managed care plans run by private insurance companies, which will double the number of long-term care residents who are enrolled in mandatory Medicaid care this year. Supporters of the strategy say it enables state officials to monitor Medicaid costs, while critics fear it incentivizes insurers to offer fewer benefits to boost profits, FierceHealthPayer previously reported.
Moreover, such shifts can lead to a "money grab" for low-cost members. For example, when New York's Medicaid program shifted $6 billion in public spending on long-term care to managed care companies, the changes resulted in a competitive frenzy to enroll people requiring minimal care. The more enrollees and the less spent on services, the more money the companies can keep.
- read the KHN article