ers, causing many patients and providers to move to other plans. The cut did not impact physician rates, but nevertheless raised concerns within the local medical community. Molina said it reinstated payment rates for those workers as of July, and “continue(s) to work with our providers to resolve any remaining issues regarding payment or coordination of care.” Senators Nelson and Hinojosa acknowledge that the shift to managed care in rural and South Texas brought big change and big challenges. But overall, they consider it successful in that HHSC quickly addressed complaints and issues along the way to avoid care disruptions, and managed care companies generally responded with improvements. Senator Hinojosa said “there are still some unanswered questions that need a closer look and analysis,” including the
impact of low payment rates on Medicaid participation and access to care, and long-term program costs. “But for the fore- seeable future, this is the model we have to work with, and we are trying to make it work.”
HHSC Deputy Chief Commissioner Chris Traylor said 2012’s expansion was “extraordinarily challenging because services were not traditionally delivered in a managed care model in those areas. So there has been a time of adaptation for providers, managed care organizations, and the agency.” While the state sees signs of cost containment in a number of areas, “I don’t think the program has matured yet to a level where a full assessment could be completed and done on the efficacy of managed care.” But the agency has intervened to overcome some of those
TMA SURVEY DETAILS PHYSICIAN UNHAPPINESS
The state appears fixated on expanding the Medicaid managed care model to save money and improve health care delivery in the program. But physician participation and satisfaction remains nearly rock bottom as many report a host of ongoing barriers within Medicaid HMOs. Besides better payment, most physicians say that reducing administrative burdens would be the first improvement they would make, according to TMA’s 2012 Physician Survey. Other findings show that a little more than a quarter of physicians (27 percent) treat Medicaid HMO pa- tients in network, whether through STAR+PLUS, which primarily covers the elderly and adults with disabilities, or STAR, which primarily covers pregnant women and children.
Physician concerns with Medicaid STAR HMOs 24%
plan to terminate one or more of their existing contracts
Reasons for termination
77% inadequate payments 75% administrative burdens 58% payment problems 54% quality-of-care concerns
48%
Physicians in a STAR HMO who report their practice experienced
specific cases in which the quality of patient care was adversely affected by the operating policies or utilization controls since March 1, 2012.
Physician concerns with STAR+PLUS HMOs 28%
plan to terminate one or more of their existing contracts
Reasons for termination
88% inadequate payments 80% administrative burdens 70% payment problems 64% quality-of-care concerns
50%
Physicians in a STAR+PLUS HMO who said they experienced specific
instances where operating policies or utilization controls adversely affected the quality of patient care since March 1, 2012.
October 2013 TEXAS MEDICINE 19
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