Block Granting Medicaid: A Model for 21st Century Health Reform? by Edward Alan Miller

Author:Edward Alan Miller [Miller, Edward Alan]
Language: eng
Format: epub
Tags: Public Policy, Political Science, American Government, State, General
ISBN: 9781317962038
Google: ngsVAgAAQBAJ
Goodreads: 18850577
Publisher: Routledge
Published: 2013-11-12T00:00:00+00:00

The Impact of the Global Waiver on Care Coordination and Smart Purchasing

Beyond procurement of managed care, EOHHS (March 2013) has concluded that provisions for selective contracting contained within Rhode Island’s original Waiver agreement were ineffective. The state, for example, proved unsuccessful in applying selective contracting to durable medical equipment. It also focused on obtaining the lowest price which, in and of itself, does not necessarily improve performance. Going forward, EOHHS plans to take “a more comprehensive approach in which selective contracting is implemented as part of an overall strategy to ensure care and services are delivered in the most cost-effective manner” (EOHHS March 2013). Importantly, the state’s Waiver extension request includes a provision removing co-payments for all services but extended family planning. This change is clearly supported by consumer advocates (Beckwith March 1, 2013; Katz March 1, 2013), though the state rejected advocates’ request that RIte Care premiums be removed as well.

In general, Rhode Island’s Medicaid-managed care options have performed very well, both overall and with respect to the new, disabled populations incorporated into such programs under the Global Waiver. As per CMS regulations, Rhode Island contracts with an External Quality Review Organization, IPRO, to annually assess the accessibility, timeliness, and quality of services provided by the plans that participate in the state’s Medicaid managed care programs: Neighborhood Health Plan of Rhode Island and United Healthcare Community Plan of Rhode Island. The most recent IPRO (October 2012) report indicates that in 2011, both health plans had achieved an Excellent accreditation rating by the National Committee on Quality Assurance (NCQA). Moreover, of 213 health plans nationally, Neighborhood Health Plan and United Healthcare Community Plan ranked 8th and 16th, respectively, based on NCQA criteria (IPRO October 2012). The same was true in 2012, with Neighborhood Health Plan and United Healthcare Community Plan ranking 5th and 18th out of the 227 health plans reviewed (EOHHS October 2012). Indeed, Neighborhood Health Plan has been ranked in the top 10 for eight consecutive years.

Since 1998, Rhode Island has measured and rewarded performance based on health plan performance relative to national benchmarks in administration, access, and clinical quality with the percentage of incentive payment being distributed across six domains: Member Services (12%), Medical Home/Preventive Care (48%), Women’s Health (10%), Chronic Care (20%), Behavioral Health (8%), and Cost Management (2%) (EOHHS October 2012). In 2011, both Rhode Island plans exhibited “strong performance on access to care and provision of well care and preventive screening services for children and adolescents, excellent access to ambulatory and preventive care for adults and generally high levels of member satisfaction” (IPRO October 2012). Neighborhood Health Plan also exhibited strong performance on a variety of acute and chronic care measures, though neither plan met goals for conducting timely initial health screenings for special enrollment populations, including disabled adults served by Rhody Health Partners and children with special health care needs served by RIte care. Based on its performance United Healthcare was required to put into effect a corrective action plan to improve performance

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