Re: States turn to private insurance companies for managed care

[Guest guest]

Anything that will help a person maintain his/her dignity is a good thing. Managed care isn't the only answer, but it is a very viable option. The key is to find a reputable outfit that won't leave you in the lurch.

There never was a good war or a bad peace.

lin

From: rumjal <rumjal@...>Flu Sent: Wed, February 23, 2011 11:08:44 AMSubject: [Flu] States turn to private insurance companies for managed care

States turn to private insurance companies for managed careBy Phil Galewitz Kaiser Health NewsMADISON, Tenn. — Two years after Holly Hawthorne was severely brain damaged when her motorcycle was hit by a bus in India, she passed a huge milestone in January: She moved out of a nursing home here and into the house where she grew up.Her mother, Diane , credits Hawthorne's managed care health plan for making the move possible. The insurer installed a mechanical chair lift in 's two-story house, in nearby Antioch, and assigned an aide to visit Hawthorne every day to help her eat, bathe and get dressed. "I'm just so grateful," says , a nurse who recently retired and now cares for her daughter.Hawthorne, a 33-year-old former dancer, is on Medicaid, the state-federal program for the poor and disabled that covers 48 million people across the country. She's also part of an emerging trend: She gets her long-term care

and other benefits through a private managed care plan that works for the state.Desperate to rein in rising Medicaid costs, Tennessee last year became the sixth state to require its frailest and costliest patients — the elderly and disabled who need long-term care — to enroll in managed care plans.At least 10 other states, including Florida, land, New Jersey and Rhode Island, are considering introducing or expanding the use of managed long-term care. The trend is sparking opposition from the nursing home industry and raising some concerns from AARP and other patient advocates.Traditionally, states pay Medicaid providers, such as doctors and nursing homes, directly for individual services. But many officials say that system makes it hard for them to predict and control Medicaid spending. Under managed care, states pay health insurers a fixed monthly fee for each Medicaid patient. The lump sum is used for all the patient's

costs, including physician and nursing home care.Managed care companies, including UnitedHealthcare and Wellcare Health Plans, say they can save money for states by keeping Medicaid patients who need long-term care at home, whenever possible, rather than in more-expensive nursing homes. They use care coordinators to monitor patients to help ensure they're getting the right care in the most appropriate setting.Hawthorne's health insurer, Amerigroup, estimates that it will spend about $37,000 a year for her care at home, compared with $55,000 for a year in a nursing home. Over time, those kinds of savings should help hold down Medicaid costs, benefiting both the state and taxpayers, says Patti Killingsworth, Tennessee's chief of Medicaid long-term care.Tennessee pays its Medicaid health plans — UnitedHealthcare (UNH) and Blue Cross and Blue Shield of Tennessee, in addition to Amerigroup (AGP)— an average of $4,400 per member

per month.AARP and some other advocates worry that, because of the incentives to restrain costs, managed care plans might make it harder for patients to get the services they need. The nursing home industry, which gets about two-thirds of its revenue from Medicaid, is complaining as well. "Managed care is not a panacea," says Joe DeMattos, president of the land Health Facilities Association, the state's nursing home lobby.But state officials around the country say they have little choice but to make more aggressive use of managed care. The long-term-care population makes up 25% of Medicaid enrollees but accounts for more than two-thirds of total program spending. Moreover, the system is headed for even more strains as Baby Boomers age.More states getting on boardSeventeen states already require other Medicaid enrollees — poor children and pregnant women, among others — to sign up for managed care. As for

long-term-care patients:•Texas, which already requires Medicaid recipients in Houston, San and Austin to use managed long-term care, began mandating it this month for enrollees in the Dallas/Fort Worth area, as well.•Illinois last year awarded contracts to two insurers, Aetna and Centene, to provide care, including long-term-care services, for 40,000 recipients in the Chicago area.•California plans to require its Medicaid long-term-care enrollees to sign up for managed care plans later this year.Given states' drive to save money, nursing home officials concede they can no longer block managed care outright. "The train is coming down the road," says Nina Willingham, president of the Florida Health Care Association, the nursing home lobby.But the nursing home industry has had some success in affecting how the health insurers do business. In Tennessee, for example, nursing homes successfully lobbied the

state to prohibit health plans from lowering their payment rates to nursing homes or dropping facilities from their networks.About 28,000 long-term-care patients are now enrolled in health plans in Tennessee. "It's gone remarkably smoothly," says the state's Killingsworth. She says 345 recipients have been moved out of nursing homes and into their own homes.One was Roland, 73, a retired truck driver who lost both legs to diabetes and entered a nursing home last July, "I thought I would never get out," he says.But then Del rio, a care coordinator at UnitedHealthcare, arranged for an aide to help him bathe and get dressed, and got a mechanical lift to help him get in and out of bed. That allowed him to move home just before last Thanksgiving.Some positives and negativesEven wary patient advocates, such as Gordon Bonnyman, executive director of the Tennessee Justice Center, say managed care offers some

pluses: Any money saved can be used to expand long-term-care services outside of nursing homes.In 2009, about 90% of Tennessee's Medicaid long-term-care funding went to nursing homes, according to TennCare, the state's Medicaid agency. As a result, there were long waiting lists for enrollees who wanted home- and community-based services. But after Tennessee awarded long-term care contracts to three Medicaid health plans, those waiting lists shrank sharply.The move to managed care has some complications. For example, most of the long-term-care enrollees also are on Medicare, the federal health program for the elderly and disabled. Since Medicare provides primary coverage for doctor, hospital and pharmaceutical services, that limits the Medicaid plan's ability to coordinate care; it might not know, for example, when a member is admitted to a hospital.Diane , Hawthorne's mother, says she is thankful for the way her daughter's

health plan has handled her care. The care coordinator, Mudry, spent months planning Hawthorne's move home. A former home health nurse, she lined up aides to provide home care and arranged for the special van to take Holly home. In addition, she has arranged for home care aides to occasionally work additional hours so Holly's mother can get some rest.Now, says , Holly "seems very content and happy, and I know she is getting more rest."Kaiser HealthNews (www.kaiserhealthnews.org) is an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan health care policy organization that isn't affiliated with Kaiser Permanente.http://www.usatoday.com/money/industries/health/2011-02-21-longtermcare21_ST_N.htm

[Guest guest]

The lurch is what must be feared in regard to private insurers. These companies

invested heavily in shopping malls and are now in danger of collapse due to the

Financial Crisis aka Mancession aka Great Recession.

See this chain of posts.

Economic_Depression/message/2481

The question now is whether the revolutions in the Middle East will touch off a

new financial crisis and so shopping malls and so insurance companies would then

go under. What should go under, of course, is the GOP and its damned doctrine

that the free market is always the answer.

>

> Anything that will help a person maintain his/her dignity is a good thing.Â

> Managed care isn't the only answer, but it is a very viable option. The key

is

> to find a reputable outfit that won't leave you in the lurch.

> Â

>

> There never was a good war or a bad peace.

> lin