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FL Medicaid plans’ scores low

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By Carol Gentry
4/3/2009 © Health News Florida

Florida pays managed-care plans $2.5 billion a year to make sure Medicaid patients in the state get taken care of properly, including getting their screenings, shots and other important preventive care on time.

But new research from 2008 shows Florida’s Medicaid managed-care plans, while doing marginally better than in 2007, still fell significantly below the national average on standardized scores accepted by the industry.

Taken as a group, Florida plans scored in the bottom 25 percent in most categories measured by the state’s contractor. In some important categories -- such as care for pregnant women, infants and the mentally ill -- Florida plans scored in the bottom 10 percent.

“Florida is lagging considerably behind the rest of the nation,” says Richard Sorian, an authority on plan performance measurement at the National Committee on Quality Assurance in Washington, D.C. “There’s nothing to brag about and several areas to be concerned about.”

Overall, there was no sign that plans in the five pilot “Medicaid Reform” counties did any better than those elsewhere. In a few categories they did worse.

At the request of Health News Florida, Sorian and two instate experts separately reviewed the conclusions of the state’s contractor, HSAG Inc. of Arizona, and other material on the Florida HEDIS scores, the industry standard for reporting on performance in managed care. HSAG's written report is expected this month (a spokesman for the company declined requests for interviews).

The views of the instate experts – Brady Augustine, president and CEO of Aggressive Analytics in Tallahassee, and Paul Duncan, chair of the University of Florida Department of Health Services Research, Management & Policy – were in line with Sorian’s. 

The plans “achieve relatively poor performance scores compared to national benchmarks,” Duncan said. 

Augustine called the results “underwhelming” and said he would have expected better, given that managed care has been developing in Florida for more than 20 years. He noted, however, that quality of care in Medicaid outside the plans could be similar or worse, since HEDIS scores apply only in managed care. 

The Agency for Health Care Administration, Medicaid’s parent agency in Florida, learned of the lackluster performance in late January in a PowerPoint presentation from the project manager at HSAG. It rang alarm bells.

AHCA offered no public release on the information, although AHCA Secretary Holly Benson’s weekly e-newsletter mentioned that HEDIS scores were under review, that she was meeting with plans to “raise the bar” on performance and that “while we are a good team, we can be better.”

But in private meetings with insurance executives, Benson reportedly lowered the boom.

“We clearly understood when we saw (the scores) they weren’t acceptable to the state and weren’t acceptable to us,” said Michael Garner, president and CEO of the Florida Association of Health Plans. “We’re determined to figure out what we need to do to get better.”

He said the association has hired a private consulting firm, the Lewin Group, to study the data and advise the plans on whether they’re accurate and how to improve them

AHCA Secretary Benson declined repeated requests from Health News Florida for interviews on this subject, citing the time pressure during the legislative session.

In a prepared statement sent via e-mail, AHCA said: “We believe in holding managed care plans accountable for serving our beneficiaries in ways that we formerly did not measure. We believe these measures are a starting point that exposed flaws in the reporting process and the need for improved service to our beneficiaries.

“We have set high standards for our plans, and now that we have data, we have asked the plans to develop corrective action plans and to invest in improving these scores.

“They responded with enthusiasm and are beginning to develop the steps they need to ensure that our beneficiaries get the kinds of outcomes we expect. In addition, we are working to develop ways to reward the high performing plans for the quality of care they deliver and to sanction low performing plans.” 

Sorian from the Committee for Quality Assurance said he wasn't surprised by the results, since his research on commercial health plans also reflected a lower performance in Florida than the nation as a whole. 

The Deep South states as a region have the lowest scores in the country. "Florida has usually done better than the rest of the region," Sorian said, "but not much." More information on this is available at the NCQA's 2008 State of Health Care Quality report.

--Contact Carol Gentry by e-mail or at 727-410-3266.