Title: Florida Center for Medicaid and the Uninsured newsletter
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Title: Florida Center for Medicaid and the Uninsured newsletter
Physical Description: Serial
Language: English
Creator: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Publisher: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Place of Publication: Gainesville, Fla.
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Holding Location: University of Florida
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NEWSLETTER



April 2006





ANNOUNCEMENTS


June 1-2
Doubletree, Tallahassee



5th Annual
Florida Medicaid
Research Conference

This year's conference will ex-
plore key topics surrounding pa-
tient empowerment and health
literacy, two major principles driv-
ing Florida's recently approved
Medicaid Reform plan.

Watch for more information in-
cluding a schedule of speakers
and online registration at FCML1 s
website, beginning April 17.



Coming Soon...
New FCMU Websitel

Look out for a newly remodeled
FCML1 website that will serve as
a reliable resource to all who are
interested in Medicaid and health
care access in Florida.

Links will provide readers with
free access to all FCML1 reports,
issue briefs, ongoing research,
and announcements.

http://fcmu.phhp.ufl.edu


Florida Center for Medicaid and the Uninsured


Chart Book: Are Adult Floridians Satisfied With Medicaid?


A chart book presenting an analysis of
adult enrollee satisfaction with the
Florida Medicaid program will be
published by FCMU this month.' The
book is intended to be a graphical and
easy-to-use guide for program
administrators and others who are
interested in understanding Medicaid
enrollees' experiences with care, and the
differences in enrollees' experiences
between the various Medicaid programs.
The major finding presented is that
adult Medicaid enrollees overall are
satisfied with the care they receive. In
many areas, Florida's satisfaction
ratings compare favorably to the
national averages reported in the 2005
CAHPS
Health Plan
Survey Percent ol Respondents Repi
Chartbook. to find a satisfactory doctor
Nearly Medicaid Overall
three- Medicaid HMO
quarters Medicaid FFS
(73%) of MedlPass Chace
enrollees in MediPass No Chace
Florida MPN NetPass
report that it MPN PhyTrust
is "not a PSN
problem" to W/. 2. .
find a good I Medaid lManaged Care Suveys, FY
primary 2 Medcaid HMO Sueys, FY205, Sta
care
provider in Medicaid. Enrollees were
also overwhelmingly positive about the
timeliness of acquiring both routine and
urgent care. Sixty percent of enrollees
reported that they .1j\I. s" got routine
care appointments and urgent care
appointments as soon as they wanted.
There were some areas in which the
reports were less favorable. Providing
adequate access to specialty care has
long been a challenge for Medicaid
programs across the country. Surveys


"Florida Medicad Adult Enrollee Satisfaction:
A Chartbook. Comparing Managed Care Ar-
rangements and Fee-for-Service, 2006. FCMU.


orli
r n









40
2005a
eCen


show that experiences vary widely. The
majority of respondents indicated it was
"not a problem" to see a specialist in
Medicaid. However, a ,;.- 'fi, ,,. t
portion of enrollees (32%) report
having d/i', ,l ii.. in seeing a specialist.
Also, the majority of enrollees reported
some level of difficulty getting
assistance by phone for the Medicaid
program.
Among the most striking findings
presented in this chart book is the
overwhelming proportion sixty
percent -of Medicaid enrollees who
report their health status as 'fair" or
"poor. While Medicaid is known to be
a program that covers many chronically
ill
J Floridians, it
ng thal it was "not a problem" is also a
urse in Medicaid: program that
72.8% covers low-
64.0% income
78.0% families,
67.5% refugees,
65.7% and others.
67.1% It is
69.0% sobering to
77.7% consider that
t% 6b/. i /n 1% the majority
n butln among hmoey res ts
ndl Medcaid Fefor Seace Suveys, FY2005 ,- of adult
ierf HealthSftatistr enrollees
consider
their health to be so poor. Another
salient finding is that a large portion of
Medicaid enrollees consider themselves
to be in 'fair" or "poor" mental health,
and almost half of those surveyed
scored within the "moderate" to
sC Cic" depression range on a
depression screener. Mental health
conditions, while more difficult to
detect than some physical conditions,
can be equally debilitating and can
affect quality of life significantly.
The book breaks down data by
Medicaid's component programs, so
that the interested reader can compare
the various care arrangements.







April 2006


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South Florida Pilot
Projects: Local Minority
Physician Network Lowers
Utilization and Cost

It is well known that Medicaid
expenditures are continuing to escalate.
States are looking for new, cost-
effective ways to finance and deliver
services. States sometimes introduce
experimental pilot projects as a means
to try new models in a limited way
before expanding these models
statewide. Pilot projects are comparable
to field experiments that investigate
important questions regarding health
care access and quality. In Florida,
several pilot programs are underway to
explore alternatives to the more
traditional Medicaid HMO and primary
care case management models.
Several of Florida's innovative
programs involve networks of providers
that manage care for a defined group of
Medicaid beneficiaries. In South
Florida, pilot projects are in place to
examine whether providing local
medical management services improves
access to and quality of Medicaid
services while also decreasing costs.
A central objective in creating these
networks was the establishment of
physician-owned-and-operated managed
care organizations with Medicaid
experience. A faculty team from the
University of Florida's Department of
Health Services Research, Management,
and Policy has conducted
comprehensive evaluations of these
'provider service networks.' The
evaluation reports are available through
the Agency for Health Care
Administration's website.2
In 2001, AHCA initiated the Minority
Physicians Network, or MPN program,
contracting with two physician-owned
organizations in which the majority of
physicians belong to racial and ethnic
minority groups: Florida NetPASS and
PhyTrust.

2 http://www.fdhc.state.fl.us/ -- Medicaid --
Quality Management -- Office of Medicaid Re-
search and Policy (MRP)


In 2004, Christy Lemak, PhD, Allyson
Hall, PhD and Chris Johnson, PhD (who
is now at Texas A & M University) of
the Florida Center for Medicaid and the
Uninsured carried out an in-depth
evaluation of the MPN program.3
Overall, the evaluations found cost-
savings associated with the network
programs. These savings were
attributed to improved utilization
management and sophisticated
information technologies employed by
the network organizations. In general,
providers were very satisfied with the
programs. The private and "local"
aspects of the MPNs offer opportunities
to monitor and support providers in
ways the current MediPass program has
not achieved. Better provision of timely
and important beneficiary information
to providers, local management of PCP
networks, and improved communication
with the Agency allow the physician
networks to run smoothly and
efficiently, leaving physicians and
patients satisfied as compared to HMO
and MediPass satisfaction.
Because previous research had not
examined how the local management of
Medicaid providers might affect
patterns of utilization (and ultimately
costs), in 2005 the researchers analyzed
utilization in each pilot program and
MediPass.4 In most cases, the pilot
programs exhibit lower levels of
utilization than MediPass. However,
utilization by type (ER visits, inpatient
visits, pharmacy, etc) varies between
networks.
This study, coupled with the analyses
done earlier, begins to build a body of
evidence that suggests that these
alternative models of care may be
improving the quality of care for
Medicaid beneficiaries. Further analysis
over a longer time frame and
incorporating an examination of specific
aspects of each alternative delivery
model will provide more insight into the
viability of the pilot projects of South
Florida.

3 "Evaluation ofFlorida's Minority Physician
Network (MPN) Program. "FCMU, April 2004.
4 "Utilization Analysis of the MPN and PSN Pro-
grams. FCMU, March 2006.









Florida's Medicaid Reform

In December, the Medicaid Reform plan
proposed by Governor Bush was
approved for implementation in Florida.
The approval of Medicaid Reform
marks the beginning of significant
changes to Florida's health care safety
net. In order to create a program that
more closely resembles employer-
sponsored health insurance, Florida's
MediPass program will be phased out
and enrollees will be transitioned into
managed care arrangements.
The reforms will go into operation on
July 1 of this year. With legislative
approval, Medicaid reform will be
expanded statewide by 2011. Between
now and June 30, AHCA will focus on
designing the implementation of the
new Medicaid program. In preparation
for the July 1, 2006 implementation
date, AHCA is engaging in a number of
activities.

First, the Agency intends to raise
awareness in Florida, especially among
Medicaid recipients, that a change is in
the works. This outreach effort is
necessary to ensure a smooth transition.
It is essential that all enrollees
understand what new choices they will
be offered. A choice counseling
program will be developed in order to
minimize confusion during transition
and enrollment. Enrollees will be
offered a greater number of enrollment
options and will be counseled as they
seek to make appropriate choices. For
example, enrollees will have the
opportunity to 'opt-out' of Medicaid in
favor of employee-sponsored insurance.
Through counseling, enrollees will
recognize if they qualify for employer-
based health insurance and whether they
are eligible to participate in the opt-out
program.
Second, the eligibility process will be
updated so that all those mandated to
enroll in reform plans, as well as those
who voluntarily do so, are matched up
with a counselor to help them make the
necessary transition.


Reform plans, as mentioned above, are
simply managed care plans that hold
contracts with AHCA to serve Medicaid
beneficiaries under the new model.
AHCA plans to restructure the
contracting process and ensure that all
new agreements made with managed
care organizations meet state and federal
requirements, and to set up an
evaluation system that determines
appropriateness of a plan's benefit
package. A new payment system will
also be designed in the coming months
which will include a comprehensive and
a catastrophic component. Additionally,
reform calls for an enhanced benefit
system, which is intended to reward
enrollees for healthy behaviors.
As AHCA moves forward in structuring
a new Medicaid program for Florida,
evidence-based decision-making will be
emphasized to the greatest degree
possible. Florida will model its program
from the experience of other states, but
will also turn to the knowledge-base
provided by health service research
institutions such as the Florida Center
for Medicaid and the Uninsured.

MedicaidReform: Duncan
Wins Reform Evaluation
Contract

Dr. Paul Duncan, the Chair of UF's
Department of Health Service Research,
Management, and Policy (HSRMP) has
received a contract from the Agency for
Health Care Administration to evaluate
the State of Florida's changes to the
Medicaid program.
This five year project will be housed
within HSRMP; however FCMU
Research Director Dr. Allyson Hall,
along with HSRMP faculty, Drs. Christy
Lemak and Niccie McKay will be co-
investigators. The project is organized
into three parts that will (1) analyze the
development and implementation of
Reform, (2) compare utilization and
expenditures for Medicaid beneficiaries
before and after enrollment in the
reform plans, and (3) conduct surveys to
assess enrollee satisfaction during the
transition process and once enrolled.


NEWSLETTER


R~lichr Lottn g i MD,' is a. -


an atv clin"icl prat ice i n11'. con-i








vices reserc i sickle- cefvll] dis-
eae Thouh is, work a,-t FCMU
he haslad out the framewor for~l ai[,l







April 2006


PO Box 100227

Gainesville, FL 32610


Florida Center for Medicaid and the Uninsured
Sha ping Healthcare Policy




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