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

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I think those are the things you need to think about. We don't
want anybody to leave here feeling like we should be paralyzed; we
just need to be careful about how we make progress and do it in
a deliberate and judicious fashion.
Ms. SMITH. Just to reinforce that, I think that what it really underscores
is that we have to continue to make some R and D types
of investments in developing the risk adjustment methodology,
which we have really not done in a comprehensive way. That is
going to be critical to the financial viability of a capitation approach.
The other aspect of it is that it means you have to continually
monitor what your outlays are and how your various expenditures
are going according to plans and then compared to your fee-forservice
system, and this will be particularly important to the Medicare
program where, right now, the Medicare program basically
loses money on every person who enrolls in a managed care plan.
Obviously, they are trying to turn that tanker around, but you
have got to continually monitor the progress of that to make sure
that you have in fact corrected it along the way.
QUESTION. Have you made any changes in terms of the kind of
data that Medicare is going to be required to collect relative to
these special needs populations? I mean, even now with the R and
D [inaudible], so in 5 years, we'll have another [inaudible].
Ms. SMITH. Right.
Mr. SCANLON. We have not made good progress in terms of the
data that Medicare is collecting on this population. In fact, a number
of States are ahead of the Medicare program in that regard.
Ms. CHRISTENSEN. I wish we had time for all the questions that
I have up here.
Thank you all for your time and preparation; it has been excellent.
Next week in this room, we will talk about quality in plans, and
the week after that we will talk about the State contracting process.
Thank you very much.
[Whereupon the forum was concluded.]