A proposal to reimburse some KanCare providers at a higher level based on patient outcomes drew skepticism from a crowd of hundreds who gathered Tuesday afternoon in a Topeka hotel ballroom.
Tuesday’s public meeting was the first in a series that state officials are hosting as they prepare to renew their federal application for KanCare, the state’s $3 billion managed care program that privatized all Medicaid services under three insurance companies in 2013.
Similar gatherings are scheduled Wednesday in Kansas City, Kan., and Wichita and Thursday in Pittsburg and Hays.
Several of the providers, consumers and caregivers who attended the Tuesday afternoon meeting complained about a lack of specifics on changes the state intends to make in the next round of five-year contracts.
But one change that was outlined — allowing the insurance companies to designate preferred providers and pay them more — drew concerns about providers who don’t make the preferred lists dropping out of the system.
Susan Mosier, secretary of the Kansas Department of Health and Environment, said the state was merely seeking feedback on the idea and that any changes would “maintain network adequacy.”
Kevin Siek, who works with Kansans with disabilities for the Topeka Independent Living Resource Center, said the state already has fallen short on that front.
“Choices are already too limited,” Siek said.
He said he knows of only one home health agency in Shawnee County that accepts Medicaid.
Sean Gatewood, a former Democratic legislator who represents a coalition of Medicaid providers called the KanCare Advocates Network, asked how the preferred provider networks would be funded given the recent 4 percent cuts to Medicaid.
“How are you going to maintain network adequacy without additional money flowing into the system?” Gatewood said. “We have a shrinking network as it is.”
Open-ended conversation
Others voiced concerns about increased bureaucracy since the state switched from a traditional fee-for-service Medicaid model to KanCare, which covers mostly people with disabilities and lower-income children and pregnant women.
They also complained that state officials had not provided enough details about their intended changes for the next round of KanCare contracts for them to share relevant feedback.
“Based on what you’ve presented so far, it doesn’t say specifically what’s going to change,” said Katherine Gallagher of McLouth, who is caring for three grandchildren on KanCare.
The crowd applauded her critique.
Mosier said the state wanted to keep the conversation open-ended.
“The reason why we don’t have the details for you is it really is about getting your input before putting pencil to paper and actually creating that application,” she said.
Mosier said the initial meetings are only the start of the process and stakeholders will have opportunities to weigh in on more detailed plans later.
The KanCare companies, she said, have provided almost $15 million in “value-added” services not previously covered under Medicaid, like weight-loss surgery and adult dental care, while simultaneously slowing the cost growth of Medicaid through care coordination.
Caseload concerns
The next round of KanCare will focus on honing that coordination and moving toward payments based on health outcomes rather than the fee-for-service model.
But there were concerns from providers and KanCare consumers in the audience that the care coordinators for the three companies — Amerigroup, Sunflower State Health Plan (a subsidiary of Centene Corp.) and UnitedHealthcare — already are struggling under heavy turnover amid large caseloads.
“Care coordinators should be more involved,” said Kelly Smith, a Kansan with a disability. “My care coordinator does nothing for me.”
Smith and Brad Linnenkamp, who also has a disability, questioned whether an outcomes-based payment model would be applicable for Kansans who have permanent conditions.
The costs of their long-term support services are largely fixed, they said.
Providers said they were concerned about the difficulty of recouping start-up costs in an outcomes-based model and asked how such a model would account for patients who fail to take responsibility for their outcomes, such as diabetics who snack on sugary candy.
The moderator for Tuesday’s event was Amy Delamaide of Wichita State University’s Community Engagement Institute.
She tried to steer the conversation toward a set of predetermined questions about the state’s priorities for the next round of KanCare. But that discussion was overwhelmed at times by complaints about the current system, like delays in processing Medicaid eligibility, long hold times on the KanCare Clearinghouse helpline and the recent reimbursement cuts.
“I’m hearing some real flexibility on which question we’re answering,” Delamaide said at one point.
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach him on Twitter @andymarso
