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An article in the Bradenton Herald last week posed the question, “Can Florida’s Medicaid reform plan be the model for the nation?” And it’s a very good question. Florida is barely into its managed-care roll out, and many questions have yet to be answered.

“Does the new system cost less because insurers are providing more efficient care or are they simply giving patients less care?” It turns out that the in the state’s pilot, the most successful groups in the HMO networks are being paid on a fee-for-service system, the same system that the state is trying to move away from. Hospitals love the amount of payment they receive in the new system, but physicians find that their reimbursement rates are low. Seriously ill patients are being bounced from provider to provider as HMO’s enter and then leave the program and patients are forced to repeatedly navigate a complicated system to get coverage for their medications and doctors.

Taking the question outside of Florida and looking at its application for the nation as a whole, and it’s more of the same. Other states are trying to implement the same type of managed-care model for their Medicaid programs. We discussed some of the lessons lessons to be learned for Medicaid managed care in a blog post a few weeks ago.

Anyone who thinks this is a good idea should think twice. Texas legislators are learning that both patients and providers alike are struggling in the face of their Medicaid reform. The state of Massachusetts just discovered that its managed care transition wasn’t the bargain it hoped for. Add to this, the data from a Bloomberg study, which showed that in five of the biggest states using managed care, the longer-term costs could eat up any potential savings that could be realized through a managed care program, and you get a system that definitely not a model to be replicated across the nation.

To find out more about how managed care is impacting community pharmacies nationwide, visit Pharmacy Choice and Access Now today.

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Comment Preferences

  •  Dear God...Rick Scott for everyone ..that is (1+ / 0-)
    Recommended by:
    FloridaSNMOM

    the ticket.  I live here in Florida.  They charge co pays..
    on Schip.  it stinks.. They pick your doctors.. it stinks.
    It is all greed. all republican all the time with corruption amuck !  Yes....Rmoney would bring Florida to the rest of you.

    We the People have to make a difference and the Change.....Just do it ! Be part of helping us build a veteran community online. United Veterans of America

    by Vetwife on Fri Oct 12, 2012 at 08:00:44 AM PDT

  •  My other half's Florida Medicaid HMO (0+ / 0-)

    has switched doctors on him 3 times in the past year. How do you manage chronic conditions that way? Now he's in the same clinic system the kids and I are in through our different medicaid HMO's. Problem with that is it takes 2 weeks to get an appointment unless you've been in the ER. They expedite follow up appointments. So you end up using the ER for urgent care instead of just emergent care, just so you can get in to see the PCP in a timely manner.

    I just went through this with the pinched nerve in my neck that has my shoulder locked up. I couldn't get an appointment with my pcp for 2 weeks, so ended up going to the ER. I had an appointment then with the clinic in less than a week after that.
    Now I have an appointment for blood work, an ortho referral, an MRI referral and a referral for a Neurologist (I had one of my 'seizures' while in the doctor's office).

    I shouldn't have had to go through the ER however to get timely care.

    "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

    by FloridaSNMOM on Fri Oct 12, 2012 at 09:17:25 AM PDT

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