Human Services Director: Iowa Medicaid provider network improved

Managed care to transition in three weeks

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DES MOINES — Iowa Department of Human Services officials on Wednesday gave updates to the Council on Human Services on the impending move to Medicaid managed care, including the development of the provider network, its communications plan and an oversight bill that’s been debated in the Iowa Legislature.

The seven-member Council advises the Department of Human Services on policy.

The state is only three weeks away from transitioning its $5 billion Medicaid plan with more than 560,000 patients over to three out-of-state managed care companies. Gov. Terry Branstad initially set a start date of Jan, 1, but the federal Centers for Medicare and Medicaid Services delayed the shift to managed care twice, ultimately approving the move for April 1.

The delays primarily centered on an inadequate provider network, which Iowa Medicaid Director Mikki Stier said Wednesday has been vastly improved. According to DHS, more than 96 percent of active Medicaid providers have signed with at least one managed-care organization and 75 percent have signed with two, and 68 percent have signed with all three. 

The state also provided a breakdown based on provider type by region and managed-care organization. In the eastern third of the state:

• AmeriHealth Caritas Iowa has contracted with 61 percent of active Medicaid adult primary care physicians and 67 percent of pediatric primary care physicians

• Amerigroup Iowa has contracted with 80 percent of active Medicaid primary care physicians and 83.5 percent of primary care pediatric physicians

• UnitedHealthcare of the River Valley has contracted with 71 percent of active Medicaid adult primary care physicians and 67 percent of primary care pediatric physicians.

The state also has worked to improve its call centers, DHS officials said, tripling staff since December to better handle call volumes.

In its December letter to DHS denying federal approval of the Medicaid switch, CMS had told the state too many beneficiaries were having problems accessing information from the call center. There was a 49 percent abandonment rate, the agency said — meaning almost 50 percent of callers hung up before they could speak to a representative due to long wait times.

That percentage since has dropped to 1 percent, DHS officials said.

State employees also partake in “secret shopping” calls, in which they call both the managed-care organizations call center and the state-run call centers to ask a series of questions and provide a score. Stier said call-center scripts then are updated based on feedback.

One member of the council, Kim Spading, a Coralville-based pharmacist, voiced some reservations about the move.

“In the Iowa Medicaid population, there are a group of people who are such high users,” she said. “And what is concerning to providers is, for those people, you cannot decrease services in a meaningful way. So where are the savings come from?”

For example, pediatric oncology patients or hemophiliac patients are very high users and there are not many ways to change their therapies that would result in meaningful savings, she said.

“Does this mean we’ll have more and more administrative loopholes to get prior authorization?” she asked. “That’s at the heart of the concerns that we have.

“I know you’ve heard that 100 times, but I want to put into perspective: One hemophilia patient will take 50 percent of our pharmacy budget in one month. That little slice of the population will not change.”

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