Florida Small Business
CEO Sounding Board
Q: How would you reform Florida's Medicaid program?
[Photo: Jon M. Fletcher]
Executive vice president/CEO
Florida Pharmacy Association
The pharmacy association, says Michael Jackson, is concerned about how the Medicaid program may redefine who's eligible to provide prescription drug benefits. The association wants to ensure that any changes in Medicaid don't exclude "qualified, Florida-based" pharmacies from serving the indigent population. "True reform of Florida's Medicaid program should also include a requirement for medication therapy management services. After all, it is medication that is not taken properly by patients that does not work and eventually costs this nation over $177 billion in excess healthcare-related costs."
Florida Hospital Association
"There are dramatic changes being contemplated by both houses of the Legislature to move Medicaid into more of a managed care program and to put all of Medicaid into managed care. How that's done is of critical importance as to whether that's successful or not. It's possible this can be done directly between providers and the state, so we don't have to bear the costs of the middleman. There's a cost associated with that. It would be better, where you can, to have this done through provider service networks created directly by the provider. Then the money is just for the delivery of care and not for the administration so much."
Florida Medical Association
"We believe that one of the problems with Medicaid is low physician reimbursement rates. That leads to patients that don't have a relationship with the doctor ending up in the emergency room for routine medical care. That's not the most efficient model for delivering healthcare. Florida is one of the lowest in Medicaid payments in the whole country. The average physician is reimbursed at 60% of Medicare rates. It's very difficult for physicians to survive seeing Medicaid patients. It's just not economically feasible."
"AARP believes older Floridians would embrace Medicaid reform that leads to better care coordination. If decisions are determined jointly by doctors, patients and other health providers, quality of care can go up. That's the best way to get a grip on rising health costs as well as to improve patients' quality of life — by providing quality, well-coordinated care. By the same token, AARP believes Floridians 50-plus would not embrace traditional managed care, where care decisions can be made at a distance by third parties." Another critical issue, says Johnson, is rebalancing the long-term care system so that "the program's bias matches that of the people it serves" by helping people remain independent in their homes rather than in nursing homes for as long as is practical.
Doing so, says Johnson, would provide more bang for the buck and improve care. "Home- and community-based care is not only how older Floridians overwhelmingly prefer to receive care, but it is significantly less expensive to care for most people in their home than in a nursing home."
"It is critical for Florida hospitals to actively be involved in achieving savings in two key ways:
1. Creating and participating in provider service networks, a form of managed care owned and operated by locally based medical providers that coordinate care.
2. Contracting as providers in networks formed by Medicaid HMOs. The regulatory framework for such HMOs should be based on transparency, accountability and high standards of care. We need to minimize disruption of existing patient-physician relationships and ensure coordinated, patient-centered care."
Florida Association of Health Plans
"If we started a Medicaid program from scratch, it's hard to believe the state would re-create what they did, which was a fee-for-service system with a state agency acting like an insurer —?processing claims, interacting with providers." The state should act more like a private employer by subcontracting its Medicaid to private health insurance companies the way some states, like Arizona, already do, he says. "You would transition the state from acting like an insurance company itself to giving it to the experts to operate in a way that hopefully ensures care is delivered and access is provided in a way that creates a more predictable fiscal environment."