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PCMH Model Adoption Appears Stagnant for 2011

Early indicators point to legislation action to adopt the Patient Centered Medical Home (PCMH) model for the state being relegated to the back burner during the 2011 session of the Florida Legislature, beginning March 8.

During last year’s legislative session, Tampa orthopedic surgeon Ed Homan, MD, then chair of the House Health & Family Services Policy Council, worked diligently to bring legislation to a vote for approval of adopting the model, arguably the best of four options presented to the Florida House of Representatives in a Medicaid Managed Care Evaluation by The Pacific Health Policy Group.

Homan, who also sat on the House Health Care Appropriations Committee, had introduced a bill combining the best of successful PCMH programs in North Carolina and Oklahoma that have saved both states significant sums while dramatically improving access to care for its Medicaid residents.

The bill, which passed out of committee but died as a result of political pressure from managed care companies, would have offered, as AARP & Medical Home Task Force member Jack McRay described it, “care management” for better health, not “managed care” for better profits.

“I don’t think it’ll move forward in 2011,” said Homan, who was initially elected state representative in 2002, and was reelected every two years until he decided not to run again in 2010. “The things I’m hearing, the current leadership in Tallahassee in the Senate and House has made a deal with managed care companies. They’re just going to turn over Medicaid to them. They want to expand the program that (then Gov.) Jeb Bush started five years ago in five counties and take it statewide, despite the fact that it hasn’t worked in the original five counties.”

State lawmakers approved the Bush initiative in 2005 for four counties in Northeast Florida and a South Florida county—Baker, Broward, Clay, Duval and Nassau—while also retaining the final decision over expanding it statewide. The pilot program, which transfers the care of state Medicaid beneficiaries to HMOs and other managed care organizations, was a privatization initiative intended to improve healthcare services while also reducing Medicaid costs.

In December 2007, after the pilot program was fully implemented in all five counties, the Agency for Health Care Administration (AHCA), the state entity that operates the managed care program for the state’s 2.6 Medicaid beneficiaries, announced that it wouldn’t recommend that lawmakers expand the program statewide.

Asked why the reluctance to move forward with Medicaid reform, AHCA spokesperson Doc Kokol said the agency wanted to address concerns raised by AHCA Inspector General Linda Keen in a 74-page report highlighting how inadequate staffing and rushed implementation issues were compromising the program’s success, while also awaiting the results of an ongoing University of Florida study of the pilot. Keen’s September 2007 report followed a critical report by Georgetown University researchers who raised similar issues and noted that some doctors couldn’t afford to provide care to Medicaid patients under the reform plan.

The University of Florida study released in mid-2009 showed the pilot program had contributed to modest savings compared with traditional Medicaid, but didn’t address access to care. Based on data available for the first two years of the program compared to two years pre-reform, provider service networks (PSNs) in the reform counties showed greater PMPM (per member per month) reductions than HMOs.

Last May, with the clock ticking after proposed legislation failed to expand the pilot program to 19 additional counties (Senate bill) or statewide (House bill), Florida lawmakers approved extending the Medicaid pilot program, which was set to expire on June 30, 2011.

Opponents of the reform program, including the Florida Medical Association and the patient advocacy group Florida CHAIN, maintain their stance that more-rigorous oversight under reform is leading to delays in receiving care and barring access to care for some people. Jacksonville dentist Michael Thomasino told The Florida Times Union that Bush’s reform plan “just adds one more complicated level to the Medicaid program.”

One Floridian criticized the privatization initiative by saying it “costs taxpayers more by providing jobs to ‘middle men,’” and another called private insurance contractors taking 30 percent off the top “stealing” and “not Medicaid reform.”

With 2011 projections looking gloomy—economists predict even deeper budget shortfalls than 2010’s $3 billion gap—and federal stimulus funds running out, state lawmakers will likely seek savings from one of Florida’s expensive programs: Medicaid's $19 billion budget.

“It’s crazy that managed care companies are managing Medicaid, but the leadership says, ‘we don’t care. We’re going to write them a check and if it doesn’t work, it’s their problem.’ It’s very frustrating,” said Homan.

Tags:

Dr. Ed Homan, Dr. Madelyn Butler, Florida Legislature, managed care companies., Patient Centered Medical Home

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