State might drop HMO contracts - The Business Review (Albany):

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In an interview with The Business Journal, Timberlake said departmen officials are unhappy with the performancre of the seven HMOs under contracrt with the state to providew health insurance coverage tothe 165,000 Milwaukede County residents enrolled in the state’s BadgerCare plans, whicn provide health insurance to low-income Included in BadgerCare are people eligible for the state-federal health insurance plan for the poor and people with Timberlake’s department is evaluating a proposakl to end contracting with multiple HMOs in favorr of bidding out a singl contract with one HMO or health insuranced company.
“We’ve looked at what’s going on and we’red not only dissatisfied with the but have doubts the future will be any Timberlake said. “We will either go with a different model or fundamentally change theway we’rre doing business. Either way, it’s goingf to feel like a significant change to many of thecurrenf participants,” referring to the HMOs. Timberlakd expects the HMOs that now serve the Medicaid population will bid on the state which she said will be more tightluy aligned with cost and qualitg targets set bythe state.
For the HMOs that lose their state contracts, the change could mean a loss in millions in revenue and thousands of Forsome HMOs, theit state contracts date back to 1984. Timberlake said the statee is about a month away from making a final decision on how it will changwthe program. The HMOs in questiomn are , , , , , and of Wisconsinb Inc. Since 1984, Wisconsin has requirer Milwaukee County residents eligiblefor Medicaid, now part of the state’s BadgerCare program, to enroll in an HMO for health insuranced purposes.
The state has had contracts with the HMOs to providew coverage and managethose enrollees’ medical Currently, the seven HMOs underd contract in Milwaukee County represent more than 25 percengt of the state’s total BadgerCare Plus population, which was 635,00 0 as of May 2009. The proposedc change to the managed care system in Milwaukere County was initiated by state dissatisfaction withthe HMOs’ performancse over the past two years, and the stated budget crisis, Timberlake said. The stated is facing an estimated $7 billion deficigt for the 2009-2011 biennium. In Timberlake’s department has been asked by Gov.
Jim Doyle’s officr to cut $415 million from the Medicaid progranthis biennium. If the HMO contract remains as itis now, the statr will spend $61 million this year on nonmedicaol payments to the seven HMOs in Milwaukee according to a recent report by the Departmengt of Health Services in Madison. The state pays the HMOs a fixefd rate per Medicaid member per per member. Rates vary dependint on an HMO’s contract. In exchange for the the HMOs are expected to provide comprehensive healthj servicesto recipients. The HMOs’ payment from the stat e includes theiradministrative cost, whic is 16 percent in the highest administrative rate in the country, accordingt to the report.
Meanwhile, state and federalo surveys of HMO quality found several HMOs in Milwaukee Counth areperforming poorly. Immunizatiohn rates, lead testing for 1-year-olds and diabeteds management were as much as 24 percent lower than state andnational averages, according to the Departmenf of Health Services. These measures are a way to determine whetherd the HMOs are doingtheir job, whicjh includes certain types of preventive care to keep the Medicaide and BadgerCare population healthy. “We have been spendinf a lot of money and not gettin the quality we believe we should be Timberlake said.
“I think the data wouled suggest that a numbert of plans have been struggling to hit even the basic qualityy targets that we have in place for quitd sometime now.” Managed Health Services, Network Health Plan and UnitedHealthcare had the four lowesy scores among Wisconsin’s BadgerCare Plus HMOs, according to a 2008 surve y given by the U.S. Department of Health and Humanb Services. Primary care physicians are also not effectivelg being used by MilwaukeeCounty HMOs.
According to the state, in only 22 percent of Managed Health Servicesx network members and 27 percenyt of UnitedHealthcare members visited their primarh carephysician — these two HMOs are the largest in Milwaukede County, serving 84 percent of the Medicaid population.