Transcript Waiving Cautionary Flags: Presentation

Evaluating Florida’s
Medicaid Pilots: Early
Reactions from Doctors
and Patients
Joan Alker
Senior Researcher
Georgetown Health Policy Institute
May 7, 2007
Our study methods for this
brief


Eight focus groups were conducted in
Broward and Duval counties in summer
2006 and Jan/Feb 2007 with Medicaid
beneficiaries
Survey of practicing physicians
conducted through membership of
Broward County Medical Association and
Duval County Medical Society from Dec
2006-April 2007
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Who is being affected by the
Medicaid pilots?



Total enrollment as of 3/07 is 165,674
 Broward enrollment is 101,115
 Duval enrollment is 64,559
Eighty four percent are children and
parents
Sixteen percent are people with disabilities
receiving SSI but not Medicare
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How are beneficiaries reacting
to the new system?
4
The process of choice


Most beneficiaries are aware that changes
are happening
Large range of decision-making
experiences so far


Some did not remember receiving state’s “Check
it Out” mailing and others were not aware that
they had to choose a plan.
Of those that had made a choice, about half had
called the choice counseling hotline.
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What choices do beneficiaries
want?

Virtually all want to keep their doctor(s)


Many cited problems doing so
By and large, they are not choosing on
differences in benefit plans. Possible
exceptions:


Parents who want dental benefit
People with chronic or disabling conditions may
be choosing on different plan drug lists
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The tools of choice

Telephone Helpline experiences



Positives: Short wait times, pleasant counselors
Negatives: Information on plan drug lists and
accurate provider directories not available
Written materials

Significant comprehension problems exist with
respect to understanding the state’s comparison
chart

Majority weren’t aware that all children are guaranteed
the EPSDT benefit across plans
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Broward comparison chart
Source: http://www.flmedicaidreform.com/english/children/Broward_Child_Eng_April.pdf
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How are physicians responding
to the new system?
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Overview of MD survey
findings



Provider participation in Medicaid
appears to be declining
Those providers that remain are seeing
fewer Medicaid patients
About half of treating providers are
reporting greater difficulty providing
needed medical care to patients
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Profile of respondents

Results based on responses from 186
doctors
 62% from Duval and 38% from Broward
 About half were specialists
 Two-thirds of responding physicians are
Caucasian
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Provider participation is
declining

Access to providers is a key issue in Medicaid


One of reform’s goals was to improve access
Twenty seven percent of those who previously
participated in Medicaid indicated that they do
not plan to join any plans

Little evidence of a countervailing trend of “joiners”
12
What kinds of doctors are
leaving Medicaid?
Nonspecialist
33%
Specialist
67%
Source: Georgetown survey of BCMA/DCMS membership. (N=36)
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What proportion of your patients
have you kept as a result of reform?
Less
than half
29%
About half
40% have kept half or
less of their patient load
11%
Most
29%
Nearly
all
30%
Source: Georgetown survey of BCMA/DCMS memberships. (N=126)
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Why might providers be
leaving?
Reimbursement
issues: “Medicaid is still
not a financially feasible
program from my
perspective. The
reimbursements do not
cover the costs of
seeing this group of
patients.”

Paperwork burdens:
“It is terrible – much
more paperwork –
patients are changed
to plans they don’t
know and to primary
doctors they don’t
know.”

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MDs’ experience with payment
amounts pre- and post-reform
About the
same
62%
Worse
32%
Better
6%
Source: Georgetown survey of BCMA/DCMS memberships. (N=99)
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MDs’ experience with paperwork for
paying claims pre- and post-reform
About
the
same
52%
Worse
42%
Better
6%
Source: Georgetown survey of BCMA/DCMS memberships. (N=103)
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How is access to care being
affected?

Possible barriers to care include benefit
limits, prior authorization and other plan
approval procedures


Over time, it is more likely that benefit limits will
affect adults.
Issue of prescription drugs subject of upcoming
brief.
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Have you noticed changes in your
ability to provide medically necessary
care to children since reform began?
Easier 1%
Harder
51%
About the
same 48%
Source: Georgetown survey of BCMA/DCMS membership. (N=67)
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About half of treating MDs report
difficulties in providing care
Were there any cases of
Medicaid patients:
Where plan benefit limits
impeded your ability to
provide needed treatments?
(N=108)
Where plan requirements for
prior authorization prevented
you from providing needed
treatments? (N=111)
Many/
Some
Just a
few/
None
53%
47%
49%
51%
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Conclusion


Clear warning signs re provider
participation and access to medically
necessary care
Consumers are confused about choices
but clear about what they want




Trusted providers
Prescription drugs
For parents, dental benefit
Complexity of new system is a challenge to
both doctors and patients
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