Florida Medicaid Reform

Friday, April 8th 2011


Letter To The Editor:

Managed Care is not the solution to rising Medicaid cost:

David Pollacks's letter to the editor suggests that moving Medicaid beneficiaries into managed care is the most effective solution to Florida’s Medicaid woes because managed-care organizations in Florida and across the country have a track record of improving outcomes while reducing costs. But is that true? A Georgetown University Health Policy Institute study of Florida's Medicaid Managed Care pilot program questions the use of for-profit managed care companies to reduce Medicaid costs. 
The Georgetown study analyzed the impact of the pilot program taking place in Broward, Baker, Clay, Duval and Nassau counties. The study concluded that there is insufficient evidence to verify claims of cost savings and also raises questions about patient access to medical care, particularly turnover among private plans that disrupts the patient-provider relationships. The study finds that some companies hoping to profit from providing Medicaid managed care services have not achieved the success they envisioned and sometimes choose to leave the program with little notice, causing a disruption for patients. In terms of managed care costs savings, the Georgetown study found "insufficient data available to draw conclusions," adding that reductions in expenditures may actually be due, in part, to patients being denied care. Furthermore, no encounter data, and no up to date data on cost savings are available to substantiate the claims made by proponents of the Medicaid HMO plans. Encounter data measures what services and medications patients are receiving and which ones are being denied - accountability that health advocates say is critical to ensure for-profit HMOs aren't lining their pockets at patients' expense.
The study concludes that instead of rushing to implement this unproven and ill-advised pilot program statewide, more reliable cost-saving alternatives should be considered such as such raising the generic prescription drug dispensing rates and pushing for adherence programs that produce better health outcomes.
So why do we want to turn over billions of dollars to private for-profit managed care companies?


Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com