Health

More than half of Iowa health care providers unhappy with private Medicaid management, state auditor's survey says

State Auditor Rob Sand's survey asked health care providers about private Medicaid management's impact on the quality of
State Auditor Rob Sand’s survey asked health care providers about private Medicaid management’s impact on the quality of medical care people receive. (Grace King/The Gazette)

DES MOINES — More than half of Iowa health care providers who responded to a survey from the state auditor said privatized Medicaid management has not led to a better quality of health care or improved access to health care.

And when presented with three positive health care outcomes created by private Medicaid management, more than two-thirds of Iowa health care providers essentially chose “none of the above.”

Democratic State Auditor Rob Sand published the results of the survey on Monday.

“At the end of the day, it appears from these numbers that the anecdotal reports of providers having problems with payment and problems providing care appear to be more than just anecdotal reports,” Sand said during a virtual news conference Monday. “There does appear to be, from a provider’s perspective, systemic issues related to all of those things.”

Iowa Medicaid Director Michael Randol said state officials value feedback from providers and have “continued to implement improvements to our Medicaid program based directly on their feedback. “Our program also includes stronger accountability measures and we withheld funds from a managed care organization that did not pay providers on time,” according to his statement, sent via email. “Oversight of our managed care organizations (MCOs) is essential to ensuring providers are supported by timely and accurate payments so they can continue to provide critical care for Iowans.”

Iowa in 2016 contracted with private health care companies to operate the state’s $5 billion Medicaid program for disabled and low-income Iowans. Then-Gov. Terry Branstad said the move would save money for the state and provide a better quality of health care.

Gov. Kim Reynolds has continued to support private Medicaid management.

Democrats and many health care advocates have been critical of the private Medicaid managed-care model, saying the companies involved prioritize profits when making health care decisions for Iowans enrolled in the program.

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In creating the survey questions, Sand said his office tried to understand issues that appeared to exist as reported by news outlets or by stakeholders in public meetings.

“It’s one thing for us to read a report that says, such and such hospital says they’re having their claims be paid more slowly,” he said during Monday’s news conference. “That’s anecdotal. At the end of the day, anecdotal evidence is evidence, but it doesn’t give us the same full picture as actually going out and conducting a full survey.”

Just more than 800 of Iowa’s 11,801 health care providers responded to the survey issued by Sand’s office, giving the results a margin of error of plus or minus 3 percentage points, according to the report.

All of the respondents also had provided care under the state’s previous fee-for-service Medicaid model, in addition to their firsthand experience with managed care.

The survey asked health care providers about private Medicaid management’s impact on the quality of medical care people receive — 51.5 percent said private management has “harmed or impeded” the quality of care either significantly or somewhat, while just 6.1 percent said private management has “improved or facilitated” the quality of care.

The survey also asked about private management’s impact on Iowans’ access to Medicaid — 54 percent said private management has “harmed or impeded” access, while just 9.9 percent said it has “improved or facilitated” access.

The majority of chiropractic and optometry providers that responded to the survey, however, responded positively or neutrally to whether the program had affected their ability to provide services.

The survey asked health care providers if the move to private management had expanded the number of Iowans who benefit from Medicaid services, increased the services available to patients or created faster access to patient information.

More than two-thirds of those who responded chose none of those.

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More than half of the health care providers who responded also said they are “extremely dissatisfied” or dissatisfied with the timeliness and accuracy of payment from the companies that administer the state’s Medicaid program.

The Auditor’s Office also sent a survey to 120 hospitals in Iowa. Those institutions were oversampled in the survey because of “their significant contributions to overall community well-being and status as often the sole provider of emergency services,” according to the report.

Of the 71 hospitals that responded, nearly 83 percent reported they were “extremely dissatisfied” or “dissatisfied” with the program’s ability to provide timely and accurate payments for medical services provided to Medicaid members.

The majority of hospitals that responded also believed services for Medicaid members have been restricted in appropriately by the managed-care organizations that operate the program.

In addition, 91.4 percent of hospitals reported that settling claims under the managed-care organizations is a more complex process. Each company managing the program has a different method for filing claims, which Sand said may be driving the negative responses to this question.

Sand called on the managed-care organizations to standardize the process for filing insurance claims during Monday’s news conference, saying it would be “more efficient for providers who are on the ground to let them focus more on actually providing care” rather than forcing them to adapt to the system.

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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