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ESCAMBIA COUNTY MEDICAL SOCIETY SEPTEMBER/OCTOBER2010 Volume 40, No. 5 President’s Message Dr. Wayne Willis Mandatory Medical Managed Care By Wayne Willis, MD CME Event Tuesday | October 12 Heritage Hall 6:00 pm Social Hour 7:00 pm Dinner Sponsor: Pat Windham/ Wells Fargo Wealth Management Speaker: Dr. Eric Nilssen RSVP: 478-0706 Founded in 1873 The delivery of Florida Medicaid services through a Managed Care Organization- MCO, has grown from 10% in 1991 to 71% in 2008. State governments around the country believed that they could control costs by having capitates contracts and other risk arrangements with MCOs. The facts are that Medicaid spending has grown about the same rate in states with and without managed care. One of the reasons for this is that MCOs have limited ability to negotiate lower costs since Medicaid fee for service already underpays providers. In 2006, a Florida Medicaid pilot program was started. It gave MCO’s more flexibility to meet special needs and promoted healthy lifestyles. It also provided “Choice Counselors” to help beneficiaries pick the right plan. A May 2009 FMA report concluded that the provision of care was no better, the administrative burden to physicians was high and access to specialist continue to be a problem. As reported in a White Paper on Mandatory Medicaid Managed Care, alternative models have shown equal or greater ability to curb rising Medicaid costs. States that have attempted widespread expansion of Medicaid Managed Care, such as Tennessee, have experienced financial collapse and reduced access to care. In contrast, North Carolina implemented a Medicaid Medical Home which resulted in improved access to care and significant cost savings while at the same time increasing reimbursement to providers. It seems that the trend in both Medicare and Medicaid is to move toward a Medical Home Model with coordination of care being directed from PCP and away from central control. This is a good thing, but still relies on the government manipulating and controlling the health care industry. I believe combining a medical home model with a consumer driven approach with things like health savings accounts (HSA) and more transparency about medical costs would allow our free market to more efficiently bring costs down. Government’s role should be safety and oversight. FMA President, Dr.Madelyn Butler has expressed her concern, as well, and hopes to influence legislative changes in how Florida Medicaid pays physicians. A telling statistic shows that only 5% of the $18 billion dollar Medicaid budget goes towards physician payments. Not surprisingly she is a supporter in the Medicaid community to champion for the medical home model of care versus managed care. Watch For Your Dues Statement October 1.

ECMS Bulletin Sep/Oct 2010

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