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‘Medical home’ sponsor left out

By Christine Jordan Sexton
 8/28/2009 Health News Florida

He is perhaps the biggest champion of the "medical home" concept - letting physicians coordinate care for patients -- but Rep. Ed Homan will nevertheless sit on the sidelines this fall when a task force meets to discuss how to implement it in Florida Medicaid.

Agency for Health Care Administration Secretary Holly Benson refused to appoint Homan to the Medical Home Task Force, which will meet this fall, despite written requests from two lawmakers, including Homan himself. 

“I didn’t make the cut and I thought it would be a given,” said Homan, R-Tampa. “Holly and I haven’t been the closest of friends.” 

Homan, an orthopedic surgeon, chairs the Health and Family Services Policy Council, which is responsible for shaping health-care policy decisions in the Florida House.

The medical home concept that he championed last session is an alternative to the controversial Medicaid Reform project that Benson helped create when she was a legislator. In the medical home initiative, the  primary care physician takes responsibility for coordinating care. Benson’s Medicaid Reform project relies heavily on commercial HMOs to manage that care for the Medicaid population,  although there are some provider-run networks in the Reform project.  Homan is known for strong attacks on the insurance and managed-care industries.

A University of Florida study on the project released earlier this summer shows the initiative has saved money. But the Legislature has been steadfast in its opposition to expanding the pilot project outside of five counties in the state. Florida’s waiver to keep intact its Medicaid reform project expires in 2011. 

In an email to Health News Florida, Benson said she didn’t appoint Homan because lawmakers are “not typically appointed to such committees.” ,

“We have asked Chairman Homan to attend all of the meetings and are eager to have his input,” Benson said in a written response. “We are hopeful that this task force will develop meaningful ideas for Chairman Homan to consider during the upcoming legislative session.” 

While he wanted to serve on the task force, Homan said he'll still have a say. “The task force does not write a bill and neither can she. I write the bill." 

Sen. Don Gaetz, the Niceville Republican who sponsored the bill establishing the task force, sent Benson a letter recommending Homan and two others for the task force. Gaetz said he sent the letter without any urging from Homan
 
He had expected Homan to serve as chairman of the task force. “I was surprised and disappointed,” Gaetz said.

Benson made her appointments to the Medical Home Task Force on Aug. 7, after the deadline in the law. At press time an initial meeting still had not been scheduled. 

The task force is charged with making recommendations to AHCA that could eventually be forwarded to the Legislature. Homan initially wanted to forge ahead and implement two medical home pilot projects last year but eventually had to settle for a year delay and the establishment of a task force to study the delivery model.
 
Medical Home Task Force members told Health News Florida they are optimistic the model will be implemented in Florida’s Medicaid program soon. 

“I think the agency will move it ahead pretty quickly,” said Andrew Berhman, president and chief executive officer of the Florida Association of Community Health Centers. 

Stephen Klasko, dean of the University of South Florida School of Medicine, said he has spent the last six to nine months brainstorming how he would change the health-care delivery system if given a chance and is ready to share his ideas. Klasko thinks that Medicaid dollars need to be redirected toward primary care physicians who should be better paid for treating patients and managing care. If primary care physicians were better paid, Klasko said, more would be willing to treat Medicaid patients. 

If those patients saw primary care physicians on a regular basis they would be healthier, he said. Healthier patients wouldn’t need as much high-cost care, such as hospitalization, Klasko said. 

“It’s not that there are not enough dollars; $18 billion is a ridiculous amount of money,” Klasko said, adding, “(but) it’s not like people are getting their money’s worth.” 

Other appointees to the task force include: 

--Dr. Coy Irvin, Board of Directors member, Florida Academy of Family Physicians
--John Kaelin, Senior Vice President, Lewin Group/ United Health Care
--Jack McRay, Florida Advocacy Manager, AARP
--Rich Morrison, Regional Vice President for Government Affairs, Florida Hospital Association
--Chris Paterson, President, Sunshine State Health Plan
--Dr. Rocky Slonaker, Medical Director/Corporate Compliance Officer, Pediatric Associates
--Phyllis Sloyer, R.N., Ph.D., P.A.H.M., FAAP, Division Director, CMS/Florida Department of Health
--Anne Swerlick, Deputy Director, Florida Legal Services.

--Christine Jordan Sexton can be reached at christinesextonwork@hotmail.com. She is co-founder of TallahasseeReporters.com.