MississippiCAN program faces growing pains

April 9, 2011

By MOLLY DAVIS
Associated Press

JACKSON (AP) — Mississippi’s 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 — Mississippi Coordinated Access Network — 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 year’s 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 patient’s needs will help eliminate redundant services and encourage patients to stick to their regimen.
“We think, by doing that and focusing on preventive care, we will reduce your program cost because it’s a ‘no brainer’ that primary care, preventive care, is a heck of a lot cheaper than in-patient hospital care,” Robinson said.
In Mississippi, about 600,000 people are on Medicaid, roughly 20 percent of the state’s 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 “medical home” concept to save money. Mississippi’s 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.
“And what happens is, since a person who’s on Medicaid can’t find a provider who’s willing to be their provider, then when they get sick they’re just going to show up in the emergency room,” said Dedeaux. “Now that’s the most expensive level of care that’s out there.”
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 patients’ 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.
“Really, the primary force in driving down costs is you’re creating a situation where people are healthier,” said Robinson. “People are getting their primary and preventive care services earlier, and yes this won’t happen immediately and overnight.”
The two companies are Magnolia Health Plan, a local subsidiary of Centene, and UnitedHealthcare, a division of UnitedHealth Group. UnitedHealthcare also administers the Children’s 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 didn’t 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.
“One thing we don’t want to do to reduce costs is to deny care or limit care,” said Tina Gallagher, president of UnitedHealthcare’s Mississippi plan, at a hearing of the House Medicaid Committee in March.
Some providers, however, say that’s exactly what’s happening.
“MississippiCAN is not resulting in improved quality of care, improved efficiency, less paperwork and more preventive care as Medicaid promised,” 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.
“At least one child went into the hospital as a direct result of refused access to the drug that was controlling her disease,” 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 pediatricians’ group, she outlined several scenarios in which MississippiCAN’s prescription policies interrupted a patient’s regimen.
Several hospital-based providers say MississippiCAN creates red tape and limitations.
“We would contend that we don’t need any more administrative planners between the patient and his providers,” Michael Bailey of the Mississippi Hospital Association told lawmakers. “There are enough already.”
Bailey said that “there are dozens of examples” 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.
“There 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,” 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.
“I’m expecting, once the program gets really rolling, that the patients are going to see better care because they’re going to have unlimited office visits, they’re going to have access to the nurse hotline, and there are just other benefits with coordinated care organizations,” 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, he’s gotten new glasses and says other treatments haven’t been disrupted.
“So far, it’s fine with me. It’s done what it said it was going to do,” said Bailey, who is not related to MHA’s Michael Bailey.
Mississippi isn’t 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.
Vermont’s 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 Mississippi’s, 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 isn’t enough time to know whether to keep, change or abolish the program.
“You’re not going to be able to have convincing outcomes in a year, and you may not have them in two years,” said Takach.