Medicaid Managed Care - U.S. Senate Special Committee on Aging

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being delivered now, where can improvements be made, and how
do we ensure that we measure the outcomes. Disabled people will
tell you they know where dollars can be saved, but managed care
must include them in this discussion.
No. 3, we must develop a credible risk adjustment payment
methodology for this population. There is a lot of talk about this
going on with Medicare and <strong>Medicaid</strong>, but we need to also be addressing
it with the disabled population.
No. 4, managed care will have to address some of its utilization
controls and benefit limits. They may not be appropriate for a disabled
population.
No. 5, managed care will also need to be aware of the concern
by many in the disabled community about the over-medicalizing of
the personal care attendant model as an example. <strong>Managed</strong> care
will need to balance its risk management and quality assurance
needs with the appropriate independence agenda of the disabled
population.
No. 6, managed care organizations must build trust with disabled
members. If a disabled member is mandated into joining an
HMO, and they are unhappy or mistrustful, they run the risk of
noncompliance or open defiance of care regimens.
No. 7, managed care must learn to contract with a new set of
players who interact and provide care for disabled people. Community-based
agencies, long-term care facilities, personal care attendants,
special home care and transportation agencies are just a few
examples.
No. 8, the service coordination role for this population will need
to be discussed. Where does it reside-at the county level, the
State, a private agency, or the HMO? There are pros and cons to
each approach, and perhaps we should test each model and decide
which is best.
Finally, No. 9, the term managed care itself may be a problem.
Many disabled individuals feel that they have "managed their care"
quite well, thank you, and they are unclear as to what value the
managed care organization brings to the table. <strong>Managed</strong> care organizations
will have to continue to educate people about the value
they bring around network management, claims processing,
credentialing of providers, measuring quality, aggregating insurance
risk, profiling physicians, and service and product discounts,
to name a few.
On behalf of my peers and colleagues here, I thank you for the
opportunity to present this information, and I will stop here and
take any questions that you may have.
[The prepared statement of Ms. Riley follows:]