The Department of Human Services has been in the news a lot lately. I want to take a moment to acknowledge the hard work our DHS family does every single day.
They work with Iowa’s most vulnerable residents to connect them with vital resources. They also make very tough decisions that affect people’s lives. So while you might read a lot of negative press, I know our Department of Human Services workers make a positive difference daily.
Still, I want to take a moment to address some of the negative media coverage related to managed care.
First, I’d like to correct the complete mischaracterization of comments I made at the April Department of Human Services Council meeting.
One media outlet ran with a headline inferring that I view Medicaid complaints as lost luggage. This carries the implication that complaints are lost and of little concern to me. That is the exact opposite of the point I was making.
I always try to speak up for the hard — and often thankless — work our staff perform every day.
I made a point to share with the council that we help thousands of people every day; however, it’s always the negative comments that we hear about.
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I also provided context, that out of the 640,000 served, the “scathing” ombudsman report cited 225 complaints, which is very, very small as a percentage.
I went on to stress that even one complaint is too many, and that we take each one seriously and are trying to do better. What’s particularly challenging about negative reports detailing individual member issues is the department’s inability to provide accurate clarification because of privacy laws.
When the media reports on member-specific issues, the department actively takes a close look to see what the issue is, with the intent to resolve it. That being said, it usually is found that the reporting is not at all reflective of what actually has occurred.
Frequently, it is reported that a managed-care organization has made no contact with a member or provider, or has failed to follow up appropriately. Upon department review, we typically find that there have been extensive communications back and forth with the member or provider.
There are multiple reports of authorizations being denied by managed-care organizations. In one instance, for example, upon internal review it was revealed that indeed authorization was granted. However, the provider was unhappy with their agreed-to contract rate.
In an attempt to work with the provider, the managed-care organization even offered to pay higher than the contracted rate, using a single case agreement. Still the provider refused this offer, wanting a contract change instead.
This provider had an authorization in place for months, all while refusing to serve the member, holding out for more money. However, that is not the headline. This is frustrating.
When you read about these situations, of course it pulls at your heart strings. These people often have very complex needs, and this is the reason our folks at DHS come to work every day — to serve Iowans most in need. However, misrepresenting or omitting the facts does not help those we serve. In many cases, it diverts staff time and resources.
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We know as a department that we have a lot of work to do, and we are committed to providing strong oversight of our managed care partners. We also are committed to working closely with providers to resolve issues that do exist. We’ve even pulled together some of our most critical and vocal providers to help in that effort.
As Gov. Kim Reynolds said in her Condition of the State address, managed care is the right decision for Iowa. This is something we think about and work on every day, because it is so important to so many Iowans. We are focused on solutions, and we are focused on a sustainable program. Many of the people we serve need us to be there for them long-term. Getting managed care right will help to ensure we are able to provide high-quality health care for Iowa’s most vulnerable, now and into the future.
• Jerry Foxhoven is director of the Iowa Department of Human Services.