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

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now has to start looking at thing like radial synovectomies at
$30 000, total joint replacement at $100,000.
If you are a payer, an insurance group or an HMO, it baffles me
why they do not understand-which would you rather pay, $1,200
for the Factor or $100,000 for a total joint replacement? Unfortunately,
we are having difficulty getting people to see that simple
little example, because they are too worried about what it's going
to cost them today.
Tenn<strong>Care</strong> gives an HMO $1,260 to take care of somebody for a
whole year. Folks, in 1 month, in July, I used $47,000 worth of
medicine. Are you going to manage me with $1,260? Let me tell
you-the reality is that my HIV doc gets paid $8 to see me. His
answer to me is. Don, I'd rather take care of you free, because it
costs me $150 to get the $8 reimbursed.
Do you think they want to manage these States such as our for
$8? Folks, it just can't be done. So I have to applaud-there are
a lot of dedicated people out there who are taking care of a lot of
these disease states, and they are not getting the credit because
they weren't even asked for their input in the beginning.
I emphasize what she said-we have got to be heard. We can't
just sit at the table and say: Gee, whiz, we had somebody from Alzheimer's,
and we had somebody here from cerebral palsy and mental
health. You have got to hear what we're saying, because in the
long run, the taxpayer is the loser, the Federal Government is the
loser, the State government is the loser, and most important of all,
the people we are trying to take care of are the losers.
Ms. CHRISTENSEN. Anybody else? [No response.]
Thank you all for coming.
I want to point out that we have three more forums in this room.
July 8, we're looking at the managed care industry and their ability
to serve people with special needs. We'll have a representative
from GAO and a researcher, and we're hoping to get somebody
from an HMO.
On July 15, we are going to look at quality and outcome measures;
and on July 22, we'll have a panel discussing the State contracting
process and the problems they face between contracting for
<strong>Medicaid</strong> managed care.
Thank you all for coming. We really appreciate your attention.
[Whereupon the forum was concluded.]