Welcome to DU!
The truly grassroots left-of-center political community where regular people, not algorithms, drive the discussions and set the standards.
Join the community:
Create a free account
Support DU (and get rid of ads!):
Become a Star Member
Latest Breaking News
General Discussion
The DU Lounge
All Forums
Issue Forums
Culture Forums
Alliance Forums
Region Forums
Support Forums
Help & Search
General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsMayo rebuffs Iowa Medicaid managed-care contracts
http://www.desmoinesregister.com/story/news/health/2016/03/24/mayo-rebuffs-iowa-medicaid-managed-care-contracts/82230958/
Iowans with Medicaid health coverage will not be able to routinely use the Mayo Clinic after the state shifts the $4 billion program to private management next week.
The three managed-care companies that will run Iowas Medicaid program told legislators this week theyve been unable to negotiate contracts with Mayos famed hospital system, which is just across the border in Rochester, Minn.
Cheryl Harding, Amerihealths top executive in Iowa, told legislators that her managed-care firm has signed contracts with three Mayo-affiliated primary care clinics in Iowa, but not with Mayos main medical center in Rochester. The other managed-care companies, UnitedHealth and Amerigroup, also said they have not obtained such contracts.
For the time being, they said, Mayo has agreed to consider single-case contracts for Iowa Medicaid recipients needing specific care that cant be provided elsewhere.
Iowans with Medicaid health coverage will not be able to routinely use the Mayo Clinic after the state shifts the $4 billion program to private management next week.
The three managed-care companies that will run Iowas Medicaid program told legislators this week theyve been unable to negotiate contracts with Mayos famed hospital system, which is just across the border in Rochester, Minn.
Cheryl Harding, Amerihealths top executive in Iowa, told legislators that her managed-care firm has signed contracts with three Mayo-affiliated primary care clinics in Iowa, but not with Mayos main medical center in Rochester. The other managed-care companies, UnitedHealth and Amerigroup, also said they have not obtained such contracts.
For the time being, they said, Mayo has agreed to consider single-case contracts for Iowa Medicaid recipients needing specific care that cant be provided elsewhere.
Comment by Don McCanne of PNHP: There are so many issues here, but it really boils down to one, which well get to in a moment.
One of primary the goals of health care reform is to provide integrated health care services. The participants in an ideal health care delivery system work together as a team to ensure that the patient receives the right care, at the right time, at the right place. The care pyramid is built on a solid primary care infrastructure that serves, not as a gatekeeper, but as a facilitator.
Examples range from structurally integrated systems such as Kaiser Permanente, to loosely integrated services provided by the various health care resources in a community - hospitals, outpatient centers, community health centers, and independent primary care and specialty practices. In todays message, Mayo Clinic represents an integrated system with its mothership in Rochester and its affiliated primary care clinics serving patients in its neighboring state of Iowa.
Thus Mayo provides integrated services that would be paid for by private insurers or employer-sponsored plans, either through fee-for-service or capitated payment schedules. Low income patients would be covered by Iowas Medicaid program.
But wait a minute. The insurers now profess to provide higher quality and lower costs through their own integrated managed care services. Iowa is following the lead of other states and turning its Medicaid program over to private Medicaid managed care companies. Although they avow quality, early experience with other state Medicaid managed care programs indicate that it is all about saving money, as quality and access deteriorate.
So what is happening to Iowas Medicaid patients who are currently obtaining their care from Mayo? It seems that Mayo is no longer in charge of integrating the health care of these patients; the private insurers are instead. For most of the patients, that means they lose access to their current care. One of the insurers will still allow patients to use the Mayo affiliated primary care clinics but not the Mayo mothership in Rochester, except by special arrangement on an individual basis. Instead of integrated care, these managed care companies are providing disintegrated care (double entendre intended).
The obvious conclusion is that integration of health care services should be a function of the health care delivery system based on patient service and not a function of an intermediary payer based on business goals.
A publicly administered and financed single payer monopsony would be designed to incentivize appropriate integration of our health care delivery system so that we really could have a higher quality health care system that brings greater value to all of us.
InfoView thread info, including edit history
TrashPut this thread in your Trash Can (My DU » Trash Can)
BookmarkAdd this thread to your Bookmarks (My DU » Bookmarks)
1 replies, 1108 views
ShareGet links to this post and/or share on social media
AlertAlert this post for a rule violation
PowersThere are no powers you can use on this post
EditCannot edit other people's posts
ReplyReply to this post
EditCannot edit other people's posts
Rec (4)
ReplyReply to this post
1 replies
= new reply since forum marked as read
Highlight:
NoneDon't highlight anything
5 newestHighlight 5 most recent replies
Mayo rebuffs Iowa Medicaid managed-care contracts (Original Post)
eridani
Mar 2016
OP
truedelphi
(32,324 posts)1. Morgan Spurlock demonstrated the tremendous advantage that Wealthy Americans
Have that the rest of us don't - they can go to foreign nations, like Thailand, and have what would cost tens of thousands of dollars of tests and procedures done for under $ 8,500 and not only that - every single thing is done in 96 hours! And under one roof. (In rare occasions, you do have to make a trip across the "campus" to an adjoining building.)
Try doing anything like that here in the USA! (Even if you have the big bucks to do so.)