By MOLLY DAVIS
JACKSON (AP) â Mississippiâs 3-month-old program to control Medicaid costs is running into early speed bumps, but proponents say MississippiCAN just needs time to root into health care institutions and the patients they serve.
Medicaid officials say the new program â Mississippi Coordinated Access Network â will improve health care while cutting costs. Some health care providers, however, complain the program has failed to reimburse them, or has disrupted patient treatments.
A committee of lawmakers will complete a review of the program by yearâs end, but experts say it may take longer to determine whether the program is working.
Medicaid executive director Robert L. Robinson said coordinated care organizations managing each patientâs needs will help eliminate redundant services and encourage patients to stick to their regimen.
âWe think, by doing that and focusing on preventive care, we will reduce your program cost because itâs a âno brainerâ that primary care, preventive care, is a heck of a lot cheaper than in-patient hospital care,â Robinson said.
In Mississippi, about 600,000 people are on Medicaid, roughly 20 percent of the stateâs population. Most are in the program because of their age or a disability, or because they are in a low-income category. The average spending per Medicaid patient per year in the state is just under $6,000, but most of the funding comes from the federal government.
The state budget for the coming fiscal year includes $763 million in state funding for Medicaid programs. The federal government will likely contribute $4.1 billion. A few other sources of money will bring the total to $5.5 billion overall.
With health care costs rising at a faster rate than other economic sectors, many states are turning to coordinated care programs based on the âmedical homeâ concept to save money. Mississippiâs own program was passed as part of a series of Medicaid changes in 2004.
Rep. Dirk Dedeaux, D-Perkinson, who chairs the House Medicaid Committee, said the program has the potential to save money and that complaints from providers may simply be the short-term result of a major program change. On the other hand, he said, doctors may become frustrated with new administrative requirements and refuse to participate.
âAnd what happens is, since a person whoâs on Medicaid canât find a provider whoâs willing to be their provider, then when they get sick theyâre just going to show up in the emergency room,â said Dedeaux. âNow thatâs the most expensive level of care thatâs out there.â
Under a traditional fee-for-service system, providers such as hospitals or clinics care for a patient, and Medicaid reimburses the provider. A patient with a chronic illness, such as diabetes, may see more than one provider and take several medications. Through MississippiCAN, a patient receives counseling from one of two private companies to manage his suite of needs.
MississippiCAN pays the companies a set per-month payment for each patient. The fee is about 5 percent less than what Medicaid would pay to providers overall for that patientsâ health care. Roberson said this short-term cost cut will be followed by larger savings. The state Division of Medicaid could not say exactly how much money would be saved.
âReally, the primary force in driving down costs is youâre creating a situation where people are healthier,â said Robinson. âPeople are getting their primary and preventive care services earlier, and yes this wonât happen immediately and overnight.â
The two companies are Magnolia Health Plan, a local subsidiary of Centene, and UnitedHealthcare, a division of UnitedHealth Group. UnitedHealthcare also administers the Childrenâs Health Insurance Program in Mississippi. Contractors were selected through a competitive-bid process.
Enrollment for MississippiCAN began in November, when Medicaid sent information to everyone who is eligible, and the program launched at the beginning of this year. Those who didnât either opt out or pick a plan were automatically enrolled in one of them.
The companies say they are cutting costs by providing a 24/7 nurse hotline to reduce emergency room visits and educating patients about staying healthy.
âOne thing we donât want to do to reduce costs is to deny care or limit care,â said Tina Gallagher, president of UnitedHealthcareâs Mississippi plan, at a hearing of the House Medicaid Committee in March.
Some providers, however, say thatâs exactly whatâs happening.
âMississippiCAN is not resulting in improved quality of care, improved efficiency, less paperwork and more preventive care as Medicaid promised,â according to a list of complaints drafted in March by the state chapter of the American Academy of Pediatrics.
The pediatricians say Magnolia, UnitedHealthcare and the state Medicaid program all have different lists for approved prescription drugs, and that MississippiCAN fails to give doctors enough choices in prescriptions the program will cover.
âAt least one child went into the hospital as a direct result of refused access to the drug that was controlling her disease,â said Dr. Sara Weisenberger, who works at the Blair E. Batson Hospital for Children in Jackson. The hospital, which is part of the University of Mississippi Medical Center, serves children from across Mississippi and says it never turns away a patient.
Speaking for the state pediatriciansâ group, she outlined several scenarios in which MississippiCANâs prescription policies interrupted a patientâs regimen.
Several hospital-based providers say MississippiCAN creates red tape and limitations.
âWe would contend that we donât need any more administrative planners between the patient and his providers,â Michael Bailey of the Mississippi Hospital Association told lawmakers. âThere are enough already.â
Bailey said that âthere are dozens of examplesâ of MississippiCAN failing to reimburse hospitals.
Still, other providers say the program works well.
Jill Bishop, executive director of East Central Mississippi Health Care in Sebastopol, says nurses at the company are accustomed to working with drug lists provided by different insurance plans.
âThere are some instances where they are having to do more paperwork, but it only seems to be associated with particular drugs in the pediatric department,â said Bishop.
Some sites, she said, report fewer problems with Mississippi CAN than with private insurance plans.
Bishop said some patients have had problems with enrollment procedures, but she thinks the companies can work out the issue.
âIâm expecting, once the program gets really rolling, that the patients are going to see better care because theyâre going to have unlimited office visits, theyâre going to have access to the nurse hotline, and there are just other benefits with coordinated care organizations,â said Bishop.
A patient in Vicksburg agrees.
Auther Bailey, 46, uses a cane as a result of a childhood injury. He also struggles with asthma. Since joining MississippiCAN, heâs gotten new glasses and says other treatments havenât been disrupted.
âSo far, itâs fine with me. Itâs done what it said it was going to do,â said Bailey, who is not related to MHAâs Michael Bailey.
Mississippi isnât the first state to try a medical home program, though the movement is young.
Mary Takach, a researcher at the National Academy for State Health Policy, said roughly 37 states have tried some variation. She said most of the programs are relatively new, so information about their effectiveness is still being gathered.
Some of the older programs, she said, are curbing the growth of Medicaid costs, if not reducing them.
Vermontâs program, launched on a smaller scale in 2006, is now expanding. It is projected to save the state 28.7 percent on cost increases projected over the next five years, according to the March issue of the journal Health Affairs.
She said most other programs, unlike Mississippiâs, provide extra monthly payments to providers for administrative work. Vermont has maintained the traditional fee-for-service payment structure, but providers also receive an additional per-month, per-member fee of $1.20 to $2.39.
Dedeaux said the Mississippi Legislature also may consider providing extra reimbursement.
Takach said other states have made major changes to coordinated care-programs after launch, such as ending contracts with third-party vendors in order to put programs under direct administration by providers.
But, she said, a year isnât enough time to know whether to keep, change or abolish the program.
âYouâre not going to be able to have convincing outcomes in a year, and you may not have them in two years,â said Takach.