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Primary care in Medicaid Pilot is hit-or-miss, report says

A consumer-group report released todayon the Medicaid Pilot -- the model for a now-pending statewide program -- says some plans gave a lot of primary care, while others gave almost none.

It calls into question a "preliminary analysis" of the program presented to state lawmakers last week by the Agency for Health Care Administration. That presentation, which covered 2009-10, didn't indicate any clear differences between Pilot counties and non-Pilot counties.

The Florida Center for Fiscal and Economic Policy study concludes that non-profit networks of hospitals and doctors called Provider Service Networks, or PSNs, "generally provided better access to care than their HMO counterparts."

The study also asserted that access to care in the Pilot counties "was significantly and consistently worse than prior to the launch" of what was originally called Medicaid Reform. In the case of some plans, the report said, "it was alarmingly worse."

The study covers three years -- from January 2008 through December 2010. It has important implications, since one of two main selling points for the Pilot was that it would improve access to care; the other was that it would save the state money at a time when the Medicaid budget was growing fast, driven by high unemployment.

Other states have followed Florida's example and thus will be watching keenly any reports on the outcome. 

Today's report is based on claims data. That's a controversial technique, since doctors who are paid by "capitation" -- a flat-rate monthly basis -- may not have incentive to take note of all encounters.

Greg Mellowe, author of the report for FCFEP, wrote in a summary that while claims data were not intended for the purpose of analyzing doctor-visit encounters, they proved effective in this case. He said he used them because the state was not making encounter data available fast enough.

The AHCA analysis was presented to the House Health and Human Services Access Subcommittee last week (see packet, pages 102-111). It indicated that one of the urban counties in the Pilot, Broward, had a rate of doctor visits that was below the state average while in Duval, it was the reverse. (Duval County encompasses the Jacksonville area; Broward includes Fort Lauderdale and Hollywood.).

Michael Garner, president of Florida Association of Health Plans, gave a quick once-over to the report this morning at the request of Health News Florida and said the underlying data need to be provided so that the conclusions can be validated by neutral parties. Without the data on which the report is based, Garner said, "it is difficult for me to assess its credibility."

Mellowe, listed on the FCFEP site as director of health research and analysis, is also policy director for the consumer group Florida CHAIN, which has been a vocal opponent of the Pilot since it began.

Florida CHAIN has asked the federal government not to allow Florida to expand the pilot statewide, or even to continue it in the five test counties (Clay, Baker and Nassau in addition to Duval and Broward).

The state needs a waiver of federal Medicaid rules to do either, since the federal government pays more than half of the cost of the state-run program.

--Health News Florida is an independent online publication dedicated to public-interest journalism. Editor Carol Gentry can be reached at 727-410-3266 or by e-mail.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.