On August 24th, the Florida Health Alliance hosted a roundtable discussion on Medicaid managed care at the Children’s Board of Hillsborough County.Speakers included: Mark Pafford, Florida CHAIN; Dr. Jay Wolfson, USF Morsani College of Medicine; Maggie Clark, Sarasota Herald-Tribune; Anne Swerlick, Florida CHAIN; and Carrie Hepburn, Tampa Bay Healthcare Collaborative. The goal of the roundtable was to collect feedback from providers, insurers, community organizations, consumers, and other stakeholders about their experiences with Florida’s statewide Medicaid managed care system. More importantly, the event focused on developing solutions for some of Florida Medicaid’s most persistent problems.
In 2014, the Florida legislature introduced Medicaid managed care in an attempt to improve access, affordability, and quality of care for low income Floridians. The roundtable found that managed care did improve some aspects of health care, but ignored or created disparities in others.
Among the categories of problems identified were:
- Access – Network Adequacy; Language & Cultural Competence; Limits on Benefits/Prior Authorization, and Administrative (enrollment, choice counseling)
- Quality – Network adequacy; Treatments and Disease Management, Language & Cultural Competence; and Administrative (Data, Complaints and Oversight)
- Affordability – Prescription drugs and hospital costs
During the breakout sessions, participants were encouraged to brainstorm and offer solutions (guided by these critical questions). Some of the potential solutions discussed included:
- Access - Coordinate with community partners to improve knowledge about available options and health literacy; Provide better incentives and reimbursement to attract more providers
- Quality - Improve data and metrics collected; Increase transparency; Establish a system for agency, plans, and providers to work together, share data, provide feedback, etc.
- Affordability - Permitting health plans to negotiate with Rx drug companies could lower costs; CA law being considered that will not allow state to pay for drugs at a cost higher than that of what VA pays for same drug; Drug pricing transparency law proposed by Klobuchar would shine light on R&D costs and what drugs cost to payers
A full summary of the roundtable discussions and details for a follow up meeting will be released in the coming weeks. To offer further ideas and suggestions, please email firstname.lastname@example.org