Health News
- Danville Newspaper Examines Problems Hospitals And Doctors Have With State's Managed-care Medicaid Program
All the talk about "Obamacare" may have obscured Kentucky's biggest health-care story, Kendra Peek of The Advocate-Messenger in Danville suggests, in a look at Kentucky's troublesome shift to managed-care Medicaid. "It's the biggest story...
- Aetna Buying Coventry, Which Manages Some Medicaid Care
Aetna will buy Coventry Health Care for about $5.6 billion as the third-largest health insurance company poises itself for more Medicare and Medicaid patients under the federal health-care reform law. Coventry Cares is one of four managed care organizations...
- Coventry, Arh At Impasse Over Medicaid; State Says Service Will Not Be Interrupted For 25,000 Affected
Though negotiations between Appalachian Regional Healthcare and Coventry Cares appear to be futile, the state is taking steps to make sure there won't be an interruption in care for the Medicaid recipients who will be affected by the impasse....
- Switch To Managed Care Happened Too Fast With Too Little Knowledge, Former Medicaid Commissioner Says
States like Kansas are looking at Kentucky as a precautionary tale for what not to do when transitioning to managed care, former Kentucky Medicaid commissioner Shannon Turner told Ryan Alessi on CN|2's "Pure Politics" Wednesday. Kansas Gov....
- State And Companies Were Unprepared For Quick Move To Managed Care, State Auditor Concludes
Kentucky officials and the companies in charge were unprepared for the switch to Medicaid managed care, State Auditor Adam Edelen said Wednesday. He sent the Cabinet for Health and Family Services 10 recommendations to improve the system, which provides...
Health News
Rushed transition to managed care is cautionary tale for other states, especially those with large rural populations
Since Kentucky's abrupt change to a Medicaid managed-care system in 2011, problems have been widespread among patients and providers, highlighting the dangers for other states, and especially rural ones, about a rushed transition to this model without sufficient preparation or oversight. Such problems could spread as Kentucky and some other states expand Medicaid under Obamacare.
?The Kentucky case is a harbinger of what can happen when states don?t allow enough time and devote sufficient resources to strengthen the Medicaid agency?s oversight capacity and systems ? or develop strong contracts and care-monitoring systems from scratch if they haven?t contracted with managed care plans before,? Debra Lipson, a senior researcher at Mathematica Policy Research, told Jenni Bergal of Kaiser Health News, writing for The Washington Post.
Patients in Kentucky's managed-care system complain of being denied treatment or having to drive long distances to find doctor's within their plans network. That's especially true of people in rural areas, such as Darlene VanHoeve in southeastern Kentucky, Bergal writes. VanHoeve has a son who needs treatment for autism at a center an hour away, but managed-care firm WellCare of Kentucky wouldn't pay for these services despite a physician's order, saying the center wasn?t in its network. In Greensburg, 8-year-old Kaden Stone loves playing baseball and riding his bike, but as a result of congenital bowel problems that have required dozens of surgeries and procedures, he needs PediaSure, his mother told Bergal. Yet, managed-care firm Coventry Cares stopped paying for it last fall, saying it was not ?medically necessary.?
Hospitals and doctors have continuously voiced complaints about denied or delayed payments from managed care companies. Kentucky health officials admit there have been problems related to the speedy switch to managed care in 2011, writes Bergal, but they insist that claims are now being paid promptly. They also insist that providers meet with managed-care companies to claim outstanding payments and that care quality has improved in the state.
Advocates for the mentally ill argue that the care system for them has deteriorated, saying plans have denied patients' long-standing prescriptions, forcing some community mental health centers to limit or cancel programs, says Bergal. ?The whole thing has been a mess,? Sheila Schuster, executive director of the Kentucky Mental Health Coalition, told Bergal.
As Medicaid rolls expand, those already in the program could be shut out of some of the key preventive services included in the new health law, says a recent study published in Health Affairs.
States that have phased in managed care more slowly have been more successful, so Kentucky's story is a cautionary tale for other states. ?It was a significant challenge,? Michael Murphy, chief executive of Aetna-owned Coventry Cares, told Bergal. ?Obviously, we learned a few lessons in Kentucky.? Perhaps this tale will keep other states from having to learn lessons too.
?The Kentucky case is a harbinger of what can happen when states don?t allow enough time and devote sufficient resources to strengthen the Medicaid agency?s oversight capacity and systems ? or develop strong contracts and care-monitoring systems from scratch if they haven?t contracted with managed care plans before,? Debra Lipson, a senior researcher at Mathematica Policy Research, told Jenni Bergal of Kaiser Health News, writing for The Washington Post.
 |
| Kaden Stone and mother, Angelina Alcott (Photo by Julie Bergal) |
Hospitals and doctors have continuously voiced complaints about denied or delayed payments from managed care companies. Kentucky health officials admit there have been problems related to the speedy switch to managed care in 2011, writes Bergal, but they insist that claims are now being paid promptly. They also insist that providers meet with managed-care companies to claim outstanding payments and that care quality has improved in the state.
Advocates for the mentally ill argue that the care system for them has deteriorated, saying plans have denied patients' long-standing prescriptions, forcing some community mental health centers to limit or cancel programs, says Bergal. ?The whole thing has been a mess,? Sheila Schuster, executive director of the Kentucky Mental Health Coalition, told Bergal.
As Medicaid rolls expand, those already in the program could be shut out of some of the key preventive services included in the new health law, says a recent study published in Health Affairs.
States that have phased in managed care more slowly have been more successful, so Kentucky's story is a cautionary tale for other states. ?It was a significant challenge,? Michael Murphy, chief executive of Aetna-owned Coventry Cares, told Bergal. ?Obviously, we learned a few lessons in Kentucky.? Perhaps this tale will keep other states from having to learn lessons too.
- Danville Newspaper Examines Problems Hospitals And Doctors Have With State's Managed-care Medicaid Program
All the talk about "Obamacare" may have obscured Kentucky's biggest health-care story, Kendra Peek of The Advocate-Messenger in Danville suggests, in a look at Kentucky's troublesome shift to managed-care Medicaid. "It's the biggest story...
- Aetna Buying Coventry, Which Manages Some Medicaid Care
Aetna will buy Coventry Health Care for about $5.6 billion as the third-largest health insurance company poises itself for more Medicare and Medicaid patients under the federal health-care reform law. Coventry Cares is one of four managed care organizations...
- Coventry, Arh At Impasse Over Medicaid; State Says Service Will Not Be Interrupted For 25,000 Affected
Though negotiations between Appalachian Regional Healthcare and Coventry Cares appear to be futile, the state is taking steps to make sure there won't be an interruption in care for the Medicaid recipients who will be affected by the impasse....
- Switch To Managed Care Happened Too Fast With Too Little Knowledge, Former Medicaid Commissioner Says
States like Kansas are looking at Kentucky as a precautionary tale for what not to do when transitioning to managed care, former Kentucky Medicaid commissioner Shannon Turner told Ryan Alessi on CN|2's "Pure Politics" Wednesday. Kansas Gov....
- State And Companies Were Unprepared For Quick Move To Managed Care, State Auditor Concludes
Kentucky officials and the companies in charge were unprepared for the switch to Medicaid managed care, State Auditor Adam Edelen said Wednesday. He sent the Cabinet for Health and Family Services 10 recommendations to improve the system, which provides...