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

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Ms. CHRISTENSEN. Thank you. [Inaudible comments.]
DISCUSSION
Ms. CHRISTENSEN. If people would write their questions out, I
think it would save time and [inaudible]
Ms. McGINLEY. Can I say something? Does anybody here work
for any Members from Pennsylvania? [No response.]
No. OK I just happened to have something specific to the State
of Pennsylvania which I would share with people.
Mr. YOUNG. At CCD, the Consortium for Citizens with Disabilities,
we have a Web page, and we are going to be putting this information
up on the Web page, too; so if anybody needs to get it
in electronic format, I put my e-mail address on the cover of my
statement, and you can either get the Web address from me-or,
Kathy, did you bring it-
Ms. McGINLEY. Actually, we have it.
Mr. YOUNG. OK
Ms. CHRISTENSEN. Tony, is your statement on the table?
Mr. YOUNG. Yes, it is over there.
Ms. McGINLEY. Here is the Web address. www.radix.net/-ccd.
That will give the general page. This testimony will be posted on
the Health Task Force page-with other information that would be
helpful, too.
Ms. CHRISTENSEN. Questions, comments?
QUESTION. I have a question for Donald Minor. [Inaudible.]
Mr. MINOR. I believe she was wanting to know, at the beginning
of the implementation of Tenn<strong>Care</strong> in the State of Tennessee, what
were the major problems as far as catastrophic disease was concerned,
and then what has helped it improve to this point.
First of all, let me say this carefully, because other States are
looking at Tenn<strong>Care</strong>, and I am very alarmed at them copying the
same program. No. 1, Tenn<strong>Care</strong> was implemented by putting the
buggy before the horse. Very simply stated, they enacted a program
without input from physicians who were specialists, and in many
instances, they did not have because they had no physician enrolled
in Tenn<strong>Care</strong> at that particular hospital. He went to four
counties before he was treated, and it took me threatening the Governor
with putting him on the front page in the morning, and he
made the telephone call to get that patient treated. So we have
been through that, and we are still going through some of those
scenarios today.
I met with Blue Cross/Blue Shield 2 weeks ago, talking about the
same problem with primary care physicians. If you are familiar
with the gatekeeper role, in order to get specialty care, you have
ot to go to the primary care physician first and physically be referred
to that specialist. Well, if you are a primary care physician
and all of a sudden, overnight, they give you 1,700 patients, and
you have no earthly idea what disease states they have, and you
call in for an appointment, and they say, "Well, the first appointment
I can give you is 3 months from now," you are looking at people
who are panicking overnight who have got to have medication
such as Factor 8 for hemophilia or protease inhibitors that you cannot
miss a day taking who are not able to get in to see a primary