Dr. Don Williamson Monday likened the division of the state into Medicaid regions to redrawing the map of Europe following World War I: Complete satisfaction is unlikely, disturbances to prior arrangements a given.
“There’s no way you can draw maps and lines on a map that do not impact somebody’s referral patterns,” Williamson, the overseer of a major overhaul of Medicaid’s delivery system, told dozens of providers and parties interested in the overhaul. “What we tried to do was minimize the impact on referral patterns, but there’s simply no way to eliminate any impact.”
Unlike that post-war Versailles map, Williamson will have another chance at drawing the boundaries, and those affected will have a chance to say where they think the final borders should be.
The preliminary map will group the state’s Medicaid patients into five separate regions, based on geography, infrastructure and how patients are referred to doctors. The regional division is the first step in the overhaul, approved by the state Legislature last month and signed by Gov. Robert Bentley.
Under the plan, Medicaid will contract with regional care organizations (RCOs) in each region to provide care to an initial pool of just under 700,000 Medicaid recipients, with at least two RCOs in each region.
Payments would be delivered under a “capitation model” that could eventually shift to one where each RCO would receive a lump sum of money to provide care to those they serve. If RCOs could provide adequate care under Medicaid’s cost estimates, they could keep any money left over. Although savings from the changes are expected to be small, supporters hope the move will incentivize preventative care and help lower hospital utilization costs, ultimately driving down the cost of the program.
While the complete move to the system won’t be finished until 2017, the first part – the map – is due by Oct. 1 of this year. There will be a 35-day comment period on the map starting on July 1, said Williamson, who also said he would like to hold three public meetings on the map at locations around the state.
Williamson also stressed the map was preliminary. As if to emphasize the point, the version placed on the easel next to him had DRAFT stamped across it in gray letters. The map, Williamson said, was the agency’s best guess at how to preserve current referral patterns in the state while creating regions that would be fiscally sound.
“It’s not a perfect map,” he said. “It may not even be a good map.”
Reactions from providers and interested parties ranged from cautious optimism to scrupulous neutrality. Rural hospitals depend on Medicaid recipients to keep their doors open, said J. Michael Horsley, president of the Alabama Hospital Association, and preserving those patterns — and keeping Medicaid patients coming — is crucial to their survival.
“We’ll have to wait to see what the individual input is (from members),” he said. “I don’t know all the referral patterns, and where the lines might need to be moved a little bit. But in general, it’s a very good first start.”
Medicaid estimates that to be fiscally sound, each RCO will have to serve a minimum of 25,000 and 30,000 patients, in order to have a large pool of healthy adults to offset the cost of treating recipients with severe health problems. The five regions range in population size, with “Region C,” taking in a number of counties in west Alabama and the Black Belt, starting with approximately 61,000 patients. Williamson acknowledged the region was on the borderline of viability, which also concerned Jim Carnes with Alabama Arise, a group that lobbies on poverty issues.
“As Dr. Williamson said, the framework of viability with participants in the system, this is at the limit of that, with high per-patient costs,” he said. “We think every region needs a strong start, and I need to learn more about the referral patterns they’re trying to maintain.”
Williamson said Medicaid patients currently seeing providers outside their region would still be able to see their doctors, as long as the doctors continue to accept Medicaid patients.
– posted by Brian Lyman