Fla. Medicaid reform pilot: More efficiency or less care?

Other questions surround the state's consumer-driven reform, but patient satisfaction remains high.

By Doug Trapp — Posted Aug. 10, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

New evaluations of Florida's Medicaid reform program found that it reduced or held spending in check during its first two years. But it's not clear if the program improved efficiency or simply reduced the amount of care provided.

Florida is in the middle of a five-year Medicaid pilot project designed to encourage enrollees to take a more active role in their health care and to achieve more predictable cost increases. Qualifying enrollees in five counties are offered a choice of health plans with varying benefits. These plans include HMOs and provider service networks, which are owned by physicians and hospitals. More than 200,000 people had enrolled in pilot plans as of June 1.

A series of evaluations have criticized the implementation and structure of the Medicaid pilot. In June, the Florida Office of Program Policy Analysis & Government Accountability -- the Legislature's watchdog agency -- advised lawmakers not to expand the pilot until data demonstrate that it has improved both access to and quality of care.

But two recently finalized state-commissioned reports by the University of Florida begin to answer some questions about the effectiveness of the Medicaid pilot.

The initiative has been shown to limit or reduce spending. The university authors compared Medicaid spending in the two largest pilot counties -- Broward and Duval -- from the two years preceding reform with spending from the first 22 months of the project. The authors found that the pilot reduced monthly spending on Medicaid enrollees who are disabled or chronically ill. The growth reduction was sharper for PSN enrollees and more modest for HMOs.

But the preliminary report has its limits, said Aaron Elkin, MD, vice president of the Broward County Medical Assn. "There are way too many variables, and they can't tell you with this information if there is really cost reduction."

R. Paul Duncan, PhD, co-author and chair of the University of Florida Dept. of Health Services, said the spending report is not comprehensive. The researchers did not have access to detailed health plan spending on services and could not say if the reform simply reduced access, or if some spending was excluded.

Duncan said the reports may not satisfy those looking for final word on the state's Medicaid pilot program, which has been controversial. "People want it to be horribly, horribly bad, or spectacularly good, but it really isn't either."

A second university report examined Medicaid enrollees' satisfaction with their health plans, physicians, and other aspects of the health system. It found few significant post-reform changes, with continued high satisfaction ratings for physicians.

Some doctors, however, are dissatisfied with the Medicaid pilot health plans' authorization process.

Marvin Schiff, MD, a family physician in solo practice in Pompano Beach, said he was forced to hire a part-time clerk to help navigate the more rigorous referral process. Seventy percent of his patients are enrolled in Medicaid. "We have to work hard to make sure that the patients get the care that's available to them," Dr. Schiff said.

In addition, the pilot reform still offers low pay for physicians, said Tad Fisher, executive vice president of the Florida Academy of Family Physicians. "I think there's a general frustration that the reforms didn't really reform at all."

The pilot project also has been complicated by Medicaid health plans limiting enrollment or dropping out. But Holly Benson, secretary of the Florida Agency for Health Care Administration, noted in a June 3 letter that Medicaid enrollees in pilot counties have more health plan choices now than before the project.

The Florida Medical Assn. opposes expansion of the Medicaid pilot, said FMA Executive Vice President Tim Stapleton. The association's board recently adopted a report critical of the Medicaid pilot reform by Arthur Palamara, MD, an FMA delegate and surgeon in Broward County. The association plans to share the report with the state lawmakers during the next legislative session, Stapleton said.

Fisher said he would like to see Florida adopt North Carolina's community care model, where physicians have input in the management of Medicaid case-management networks with medical homes.

Back to top


Fla. reduces Medicaid spending, but how?

Florida's pilot Medicaid reform has restrained or reduced per-enrollee spending in its first two years of operation, but it's not clear if enrollees received more efficient care or simply less care, according to a state-commissioned analysis of the reform. Average per-member, per-month spending declined particularly for enrollees in provider service networks in the two major counties in the five-county pilot, Broward and Duval. Their tallies:

Medicaid enrollees with disabilities Other qualifying Medicaid enrollees
All enrollees
Pre-reform (July 2004-June 2006) $809 $127
Reform (September 2006-June 2008) $783 $131
Difference -$26 $4
HMO enrollees
Pre-reform (July 2004-June 2006) $668 $126
Reform (September 2006-June 2008) $772 $138
Difference $104 $12
Provider Service Network enrollees
Pre-reform (July 2004-June 2006) $894 $128
Reform (September 2006-June 2008) $799 $112
Difference -$95 -$16

Source: University of Florida, Dept. of Health Services Research, Management and Policy, July

Back to top

External links

University of Florida's Dept. of Health Services Research, Management and Policy on Medicaid reform (link)

Florida Office of Program Policy Analysis and Government Accountability, Medicaid reform reports (link)

Florida Agency For Health Care Administration Medicaid reform reports (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn