State might drop HMO contracts - The Business Review (Albany):

iqukikofor.wordpress.com
In an interview with The Busines Journal, Timberlake said department officials are unhapph with the performance of the seven HMOs under contract with the statee to provide health insurance coverage tothe 165,000 Milwaukee County residents enrolled in the state’s BadgerCare which provide health insurance to low-income Included in BadgerCare are peoplwe eligible for Medicaid, the state-federalk health insurance plan for the poor and people with Timberlake’s department is evaluating a proposal to end contracting with multiplde HMOs in favor of bidding out a singlde contract with one HMO or health insurancw company.
“We’ve looked at what’s goinfg on and we’re not only dissatisfied with the but have doubts the future will be any Timberlake said. “We will either go with a differentf model or fundamentally change theway we’rs doing business. Either way, it’s goint to feel like a significant chang e to many of the current referring tothe HMOs. Timberlakw expects the HMOs that now serves the Medicaid population will bid on the state which she said will be more tightly alignerd with cost and quality targets set by the For the HMOs that lose their state the change could mean a loss in millions in revenue and thousandsof enrollees.
For some their state contracts date backto 1984. Timberlake said the state is abouy a month away from makinb a final decision on how it will changthe program. The HMOs in questio n are , , , , , and of Wisconsin Inc. Sincre 1984, Wisconsin has required Milwaukee Countt residents eligiblefor Medicaid, now part of the state’sw BadgerCare program, to enroll in an HMO for health insurance purposes. The state has had contracts with the HMOs to provide coverage and managrethose enrollees’ medical care. the seven HMOs under contract in Milwaukee Countgy represent more than 25 percent ofthe state’s tota l BadgerCare Plus population, which was 635,00 0 as of May 2009.
The proposed changer to the managed care systemj in Milwaukee County was initiated by state dissatisfaction withthe HMOs’ performance over the past two and the state budget Timberlake said. The stat e is facing an estimated $7 billion deficit for the 2009-2011 biennium. In response, Timberlake’s department has been askerd by Gov. Jim Doyle’s office to cut $415 million from the Medicaidc programthis biennium. If the HMO contract remains as itis now, the stated will spend $61 million this year on nonmedical paymentsw to the seven HMOs in Milwaukee County, accordingh to a recent report by the Department of Health Servicees in Madison.
The state pays the HMOs a fixed rate per Medicaif memberper month, per Rates vary depending on an HMO’s contract. In exchange for the the HMOs are expected to provide comprehensive health services to The HMOs’ payment from the state includesa their administrative cost, which is 16 percenf in Wisconsin, the highest administrative rate in the according to the report. state and federal surveys of HMO qualit y found several HMOs in Milwaukee County are performing Immunization rates, lead testing for 1-year-olda and diabetes management were as much as 24 percenf lower than state and national averages, accordingv to the Department of Health Services.
Thess measures are a way to determine whetherr the HMOs are doingtheir job, whic includes certain types of preventive care to keep the Medicaidd and BadgerCare population healthy. “We have been spending a lot of money and not getting the qualit y we believe we shouldbe getting,” Timberlakwe said. “I think the data would suggesrt that a number of plan s have been struggling to hit even the basic quality targeta that we have in place for quit sometime now.” Abri, Managedr Health Services, Network Health Plan and UnitedHealthcarde had the four lowest scores among Wisconsin’s BadgerCare Plus according to a 2008 survey given by the U.S.
Department of Healty and Human Services. Primary care physicians are also not effectivelyy being used by MilwaukeeCounty HMOs. Accordingf to the state, in 2008, only 22 percent of Managed Health Services network members and 27 percenyt of UnitedHealthcare members visited their primary carephysician — thes two HMOs are the largest in Milwaukee serving 84 percent of the Medicaid population.