The tempest regarding the introduction of managed care to Kentucky's $6 billion Medicaid system is one that has generated more heat than light.
As state auditor, I am trying to fix that. Recently, I issued 10 commonsense proposals aimed at providing immediate fixes to the state's new Medicaid managed care system and announced the creation of a unit in the auditor's office to monitor the long-term effectiveness of the program that provides health care to more than 700,000 Kentuckians.
We ought to be future-focused rather than merely engage in the blame game — though there is certainly enough to go around.
The Cabinet for Health and Family Services either forgot or failed to learn the lessons of the difficult Passport Health Plan roll out 14 years ago — and in doing so allowed history to repeat itself.
The managed care organizations, despite being multibillion dollar health insurers with expansive multistate operations, stumbled in their introduction to Kentucky with inadequate systems, staffing and communication to their partners.
And to a lesser extent, Kentucky's provider community was reluctant to adapt to a system designed not just to pay claims as quickly as possible but also to scrutinize each and every claim for potential errors and abuse.
Nearly all states are using managed care to varying degrees in an effort to save money while providing better health care to struggling citizens. Managed care organizations often do a better job of weeding out Medicaid waste and fraud and advocating the use of preventive care for members — a win-win for states striving to reduce costs without sacrificing quality of care.
Managed care is the right approach for Kentucky, provided it's done right. We have an obligation to:
Taxpayers, who expect their dollars to be handled appropriately and to be used only for medically necessary services for the state's struggling citizens.
Providers, who are often making significant sacrifices to care for Medicaid patients and deserve to be paid for legitimate services in a timely manner.
Vulnerable citizens, who don't deserve to be caught up in bureaucratic quagmires when they need care.
Last month, I wrote to the leadership of the managed care organizations requesting information regarding the progress of paying provider claims and the amount they have billed taxpayers. Such information is critical to forming a baseline by which my office will evaluate the future performance of the companies.
The complex results indicate the difficulty we have in holding private firms accountable as they do important work. Although the data indicate the billing concerns were justified, it is extremely difficult to produce apples-to-apples comparisons among the MCOs.
One observation from our review that troubles me is that the three new MCOs are sitting on a quarter of a billion taxpayer dollars while small-town hospitals, doctors and other health care providers are struggling to pay employees and, in some cases, have had to extend or open lines of credit to continue operating.
Kentuckians are owed an explanation.
I am encouraged by the willingness expressed by the cabinet and MCOs to consider my recommendations and recognize that they are already taking steps to improve the system. The proposals would bring greater accountability and transparency to perhaps the most complex function of our government. But they merely reflect the beginning of our oversight of Medicaid rather than its conclusion.
Medicaid is the second-largest expenditure of our government. There are more people on Medicaid than children in our public schools. The Medicaid Accountability and Transparency Unit in the auditor's office will focus solely on making our Medicaid system more effective, efficient and honest.
By working together — setting political agendas and other considerations aside — all the relevant stakeholders have within them the potential to provide our most vulnerable with a sound, efficient and workable Medicaid system, one in which our taxpayers, patients and providers get a square deal.