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

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> In building up and maintaining their own staff expertise, the agencies face
significant constraints that emerge from outmoded State personnel systems and from
minimal investments in staff development.
<strong>Medicaid</strong> agency managers routinely
complained to us about State personnel California's "Broken" Civil Service System
systems that make it enormously -
difficult for them to recruit people with
in
experience in the managed care
'California-s vil Service System is broken.:': Today,
~~~~~~~~~there
are no rewardsjfor outstanding per'fornnance.,
and no consequencesforrpetfonnance. his
industry, to rotate agency staff among dfficult to hire outstanding applicants, and iris.
different positions, and to give difficult to fire rte 'bad apples.' Salary is bas d on
sufficient rewards based on longeviry, not productivity. In a rapidly dianging
performance) 5 Every bit as much, technological environment, workers lack adequate:
they expressed concerns about the training. It is a topsy-turvy world characterized b'y
meager resources available for staff
development. Rarely, for instance, (From 'Conmperinve Government:. A Plan for Less
could they even send an employee to an Bureaucracy, More Results. Office of the Governor.
out-of-State conference.
Over time, many officials stressed, the consequences of this situation become troubling.
Capable, experienced staff leave. Some career staff end up in roles for which they are illsuited.
Some become too dependent for day-to-day learning on the staff of the health
plans which have contracts with the <strong>Medicaid</strong> agency. A number of plan representatives
reminded us that they regularly educate <strong>Medicaid</strong> staff about how managed care works.
Challenge: #3: Instilling a New Organizational Mission and Culture
For <strong>Medicaid</strong> agency staff accustomed to the fee-for-service routines, managed care
portends fundamental change. It means that they must reorient themselves to an agency
that is beginning to focus on beneficiaries rather than on providers and to define itself
more as a health care purchaser than a bill payer. Agency leadership must find ways of
enabling staff throughout the organization to make this transition.
Toward the later part of Stage I and into Stage II, it becomes increasingly apparent that
managed care represents more than marginal change affecting one sector of the <strong>Medicaid</strong>
agency. In fact, it looms as a paradigm shift, recasting the role of the <strong>Medicaid</strong> agency
and most of its workforce. A before and after analysis prepared by the Minnesota
Department of Human Services reveals the extent of this shift (see table 2).
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