Decades-long battles over incorporating managed care in the Medicaid program came to an end in 2014 when Florida fully implemented a statewide managed-care program that is mandatory for most beneficiaries, from the cradle to the grave.
Agency for Health Care Administration Secretary Liz Dudek notes that the transition from fee-for-service to managed care took less than the three years the Legislature allotted the agency when it passed the sweeping changes in 2011.
“It was just a couple of months, but it was still ahead of time,” Dudek proudly told SaintPetersBlog in a sit-down, year-end interview at her Tallahassee office on December 15.
The number of enrollees in managed care plans in 2014 grew throughout the year as the agency implemented the program. The Statewide Medicaid Managed Care program is bifurcated. There is the managed medical assistance program, which covers medical care, dental care and behavioral care and the long-term care program, which covers home and community based services and nursing facilities.
As of November, there were more than 2.7 million patients enrolled in managed care, state reports show. Just 832,873 people remain in the fee-for-service system, which is when a patient sees the doctor of their choice and isn’t treated in an HMO or “provider service network” environment.
Just six months earlier — before managed care was fully implemented — there were 1.4 million people in fee-for-service Medicaid.
Dudek said there were thousands of staff hours and upfront work — from procuring the contracts to agency outreach efforts, including countless seminars, webinars and presentations across the state.
At times, Dudek said, the agency and its contracted choice counselors even went to recipients’ homes to help enroll them in the program if they were having difficulty. A phased-in roll out of managed care also helped the agency learn as it went along. It was able to avoid missteps that were identified in earlier rollouts and duplicate efforts that were effective.
Now that the program is implemented the agency has switched gears from start-up to steady work, she said, adding now the monitoring and tracking and begins. Part of that work also includes reviewing Medicaid rules to ensure they align with the new Statewide Medicaid Managed Care initiative. Agency for Healthcare Administration spokesperson Shelisha Coleman said there are 50 Medicaid-rleated rules currently under review by the agency.
The managed medical assistance program is served by 14 general managed-care plans and five “specialty” plans, designed for those with AIDS or for children with special needs.
Staywell Health Plan is the largest provider with a 22.7 percent share of the entire market. Sunshine State Health Group and Amerigroup follow with a 13.9 percent market share and an 11.9 percent market share, respectively
The agency has a central complaint hub where providers and patients can submit in writing their issues with the program. Dudek said there were 5,599 “issues” registered with the state since the managed medical assistance program was rolled out this summer. That translates to 2 issues per 1,000 members, she said.
The issues behind the complaints run the gamut, from providers not being paid in a timely manner to coding problems. Some of the complaints, Dudek said, were ones the agency heard from providers even before mandatory managed care.
Providers — not patients — are the ones seeking out the complaint hub, Dudek said, adding, “there are occasionally recipient issues.”
“We feel it’s really good because that means recipients are getting the services,” she said of the smaller number of issues being raised by patients. For providers, though, “it’s doing business differently,” she said.
There aren’t any systemic problems with the program based on the issues registered in the complaint hub, she said. But if she “had to choose” an area where there are more registered concerns than others, it would be with transportation services as well as some of the therapies patients are offered.
Managed long-term care has a smaller population — roughly 83,000 people — but it represents a larger percentage of costs. There are seven long-term care plans serving these patients and none is bigger than Sunshine State Health Plan, with a 38 percent market share. United Healthcare follows with a 23.8 percent market share and American Eldercare with 15.6 percent of the market.
In November 63,627 people were enrolled in the long-term care program.
Visitors to the complaint hub in the long-term care program also are providers. The agency has received 2,773 issues that have been raised at the complaint hub, which is about 32 issues per 1,000 long-term care enrollees.
Dudek attributed the higher number of complaints associated with the long-term care program to the agency making outbound calls to providers, asking them how the program was going. If providers registered any concerns they were included in the complaint hub.
“We solicited some of them,” she said.
Transforming the program from fee for service to managed care is no small feat, said Mike Hansen, a former budget chief for Gov. Jeb Bush and the Florida Legislature. He’s also a former secretary for the Agency for Persons with Disabilities. Hansen now is president and chief executive officer of the Florida Council for Community Mental Health Centers.
“It took a lot of work on AHCA’s part and it was a very short time frame,” Hansen said. “This is a complicated program and it serves 3 million people.”
A 39-year state health-care policy veteran, Dudek said the work was accomplished because of agency teamwork in every arena–from Medicaid to information technology to health quality assurance–and a good senior management staff. She praised the deputy secretary for Medicaid, Justin Senior, and Division of Health Quality Assurance Deputy Secretary Molly McKinstry, among others.
“In the beginning, we thought “Oh my gosh. How are we going to do this?” Dudek said of the task. “Once we did it, we were like, ‘Wow,’ not believing that we had done it. It caused a celebration in house.”