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

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Finally, we believe that high quality managed care programs for <strong>Medicaid</strong> populations require
a strong public/private partnership. We have this in Wisconsin because we have made it
happen. Our contract requires IMOs to a our public meetings anl work together with
community-based organizations and counties. We foster informed and proactive advocacy
through HMO advocates, state-sponsored ombudsman and nmeous public workgroups and
meetings. We report on our results - good and bad - and work together on program
improvements. We keep top policy m-as informed through publications such as Eirward.
our monthly managed care newsletter. We highlight 'best practices" at our public meetings.
In general, we use our contract requirements and the resoures of the State <strong>Medicaid</strong> program
to foster information-sharing and trust-building.
We have found this approach to be very effective in the ccu± fmntimanaged carem
environment This is why 19 of the 25 HMOs licensed in Wisconsin contract with <strong>Medicaid</strong>,
why advocates and counties are pushing us to expand managed care to the elderly and
disabled, and why policy makers in Wisconsin look to the <strong>Medicaid</strong> coatract as the standard
for commercial managed care.
The results of <strong>Medicaid</strong> managed care in Wisconsin have been significant savings and better
health care for recipients. We estimate managed care has saved Wisconsin taxpayers over
$100 million, from 1990 to the present time, compared to traditonl <strong>Medicaid</strong> foe-for-service.
In 1996, we saved $16 million over comparable fee-for-service expenditures.
Access to care has improved for <strong>Medicaid</strong> recipients enrolled in our mandatory HMO program
for low-income women and children as measured by our 1995 EHMO/FcP-Fcr-Service
Comparison Report. For example. in 1995, HMO recipients visited <strong>Medicaid</strong> health care
providers more often than their fee-for-services counterparts and visited mergency rooms half
as often as their fee-for-service counterparts. Children in <strong>Medicaid</strong> RMOs receive more wellchild
visits, more imminizations and more specialty care. Women in liMOs were more likely
to receive at least one Pap test and had fewer Cesarean sections.
What lessons have we learned about the critical capacities of states to operate suczcssful
managed care programs, especially for persons with special health care needs?
States and managedscare plans need enough time to pla sign contracts, enroll recipients, and
develop necessary relationships to provide the quality managed care programs states now
expect. They need to be able to develop - and enforce - strict contract performance
standards. To develop effective contracts, state <strong>Medicaid</strong> prognrms.must shift to a new
'buyer" mindset. We see ourselves purchasing for outcomes, rather than paying for services
or regulating for potential violations.
But strong contract require ts alone will not ensure high quality managed care programs.
Stares alsoined the ability to maxmize significant resources, either through redeployment,
contract staff, or in rare instes in these times, nw -staff, in order to create the
infrastrucnure needed to support effective contract enforcement. In Wisconsin. we have a
small managed care section of 21 fiull-time employees. Two of these employees are
'borrowed" from other divisions in our Departmet. About 10 - 15 staff from other areas in
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