dumping patients – part 3

Managed health care for the poor of Louisiana? Who will ultimately get stuck with the bill? I simply cannot fathom that private insurance will pay for any of it, when people who do have insurance have to fight tooth and nail to get them to simply pay a portion of the bill. And read the fine print below – notice the word “negotiate” – why do people have to negotiate what they pay for in advance via insuramce premiums?

Managed health care plan unveiled for state’s poor
Parts of Medicaid would be privatized
Tuesday, December 02, 2008
By Jan Moller

BATON ROUGE — Louisiana lawmakers got their first extensive look at Gov. Bobby Jindal’s health care proposal Monday, as members of the state House questioned the timing and cost of a sweeping plan to revamp how the state delivers and pays for health care to the poor.

Health and Hospitals Secretary Alan Levine joined representatives from private hospitals, insurers, doctors and Louisiana State University in a day-long briefing on the “Louisiana Health First” initiative before a rare out-of-session meeting of the state House of Representatives.

“This is the first step as we move toward the regular session,” House Speaker Jim Tucker, R-Algiers, said. The governor’s plan aims to turn over large chunks of the state Medicaid program for the poor to private managed-care companies in an effort to control costs and improve health care outcomes in a state that fares poorly on a broad range of national health indicators.

“It is time for us to do something different, and dramatically different,” Levine said. “We cannot change the system on the margins.”

But the plan has drawn criticism from hospitals and doctors’ groups that favor a different approach. “The hospitals out there are very concerned about how we’re going to pay for all that,” Louisiana Hospital Association President John Matessino said. Louisiana’s $6.7 billion-a-year Medicaid program currently operates under a traditional fee-for-service model, where the state pays bills submitted by doctors, hospitals, pharmacists and others willing to treat poor patients.

If approved by state legislators and the federal government, Jindal’s plan would set up managed-care pilot programs in New Orleans, Baton Rouge, Lake Charles and Shreveport. Most Medicaid recipients would work with state-approved counselors to choose between two or more private health plans, while those who don’t make a choice would be automatically enrolled in a care network.

Rather than a fee-for-service model, insurers would be paid a flat monthly fee per enrollee, which would vary based on the health of the patient. The plans would then negotiate fees with doctors, hospitals and other participants in the network and work to ensure that patient care is coordinated among those providers. Eventually, the plan would extend coverage to 106,000 people who currently have no insurance.

Part of the cost would be financed by persuading the federal government to forgive what it says Louisiana owes for past overspending. Other dollars would come from money that now flows to the LSU Charity Hospital System for treating the uninsured, and from savings that would result from improved care coordination.

Jindal’s team has said the Medicaid program is financially untenable in its current form, as costs are rising faster than inflation and will eat up an increasing share of the state’s discretionary budget in future years.

But Rep. Herbert Dixon, D-Alexandria, questioned why the state is rushing to win federal approval for its plan at a time when the incoming Barack Obama administration is planning large health care changes of its own. “Why do we need to act now when a comprehensive federal plan is forthcoming?” Dixon said.

Levine said the state does not want to wait for Washington to act, and that the changes it is proposing are consistent with health care proposals that have been advanced by Democratic lawmakers on Capitol Hill. Rep. Hunter Greene, R-Baton Rouge, said the state could be falling into the trap of using one-time money to pay for recurring expenses if it pays for the program with federal “disallowance” dollars.

And Dr. Floyd Buras, a Metairie pediatrician and a former president of the Louisiana State Medical Society, which opposes the plan, said steering Medicaid recipients into managed-care networks would restrict patient choice. “The problem with traditional managed care . . . is that it’s managed cost,” Buras said.

He said the medical society supports a proposal, released earlier this year, that would provide health insurance vouchers to the poor that would be financed with money that now pays for care in the charity system. The plan went nowhere after being presented to lawmakers last spring.

~ by maringouin on Wednesday, December 3, 2008.

%d bloggers like this: