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“Just like the doctors want to be available for the rewards if they take the risk, we have to get patients back in the game to take more control of their well-being.”

saw those three different locations, you would think we had gone through and counted that three times. Our number of 3,000 is predicated on a [single] pro- vider, not three different locations.

Texas Medicine: Recent census num- bers show a quarter of Texas’ popula- tion remains uninsured. At the same time, there appear to be divisions in the state about whether to participate in the Medicaid expansion under health system reform. What is your view on the expan- sion? Could waiver flexibility make it more feasible?

Texas Medicine: What is the status of WHP? Do you have enough physicians participating, and in gauging that, are you considering the difference between the one- and two-doctor practices that can take a handful of patients, com- pared with clinics no longer allowed in the program that were taking hundreds of patients?

Dr. Janek: The state has always had an eye on continuing WHP as a Medicaid program with the exclusion of abor- tion providers and their affiliates. At the end of the day, my job is to make sure we’ve got a system — whether it’s a Texas WHP or a Medicaid WHP — that provides basic primary and preventive care, including family planning, to the 115,000 to 130,000 women who need it. I will do this as long as we can do it as a Medicaid program. If that’s not al- lowed by [federal] law — and we’ll let the courts and CMS [Centers for Medi- care & Medicaid Services] figure that out — then I will do it as a state-funded only program. Either way, I can do it. But we won’t know the answer to that until all of these court cases are resolved. We started making phone calls to ex- isting providers, and last spring we cer-

32 TEXAS MEDICINE January 2013

tified a lot of them. We want this to be easy for the doctors. We want this to be seamless for the patients as they tran- sition from the old Medicaid program to the new Texas WHP if that becomes necessary by court ruling, or if they transition from being Medicaid eligible. We don’t want them to be caught in the middle of the conflict. We’re confident we have enough doc-

tors. We’ve found 3,000 doctors. There was another big provider who [un- der state law] is no longer allowed — Planned Parenthood. We’ve got most of that business [covered]. Now that there’s an opportunity to take care of those pa- tients, [doctors are saying], “I’ll do it.” We’re now in the process of gauging the capacity issue: If there are four doctors in a group practice, how many patients can they take? But we know our geog- raphy is good. We’ve got a good spread of doctors all over the place. And we are going to make sure our capacity is good and well. We got a bit of a bum rap. Some of it was self-inflicted because we had a provider list — not an official database — that had not been well fil- tered. So you might have one doctor [on the list] but three different office loca- tions. And yet if you went through and

Dr. Janek: First and foremost this is a decision for the policymakers. I agree with the governor. It seems enticing to take federal money, but are you going to have to spend money later once you’ve entered into that system, and what’s that cost going to be? I think everyone would agree that the Medicaid system is broken, and to go further down on that limb for the short-term effect of 100-percent fed- eral dollars can put the state in big dire straits later on. My job is to find how we can do more with the resources we are given. Rather than provide all services to all people in Medicaid, I’d like to see a system that gives us more flexibility, not necessarily by waiver, but maybe by some change in federal law. I think we can design a system that fits Texas. [That includes] utilizing our medical schools. They are [located] where the Medicaid population centers are, and to the extent we can leverage better Medicaid funding for the medical schools and ask them to take care of that Medicaid population, now you’ve taken that dollar of straight [state] medical school funding with no match and turned it into $2.47, let’s say.

Texas Medicine: Now that the state has gone ahead with the expansion of Medicaid managed care, what is HHSC doing to hold these health plans accountable?

Dr. Janek: We are constantly revisiting those contracts. We get more sophisti- cated all the time in how we build those contracts. We look at not whether it takes 90 or 120 seconds for the phone

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