She added that health plans seek administrative simplifica-
tion, too. Billing systems are just as complicated for HMOs as they are for physicians. Encouraging the use of electronic por- tals for claims submissions saves both physicians and health plans time and money.
“It costs health plans money to deal with appeals, just like it costs doctors.” UnitedHealthcare Community Plan of Texas has done simi-
lar outreach in South Texas and is preparing to roll out a qual- ity incentive payment program for primary care physicians, Chief Executive Officer Norine Yukon says. Its case manage- ment program helped practices foster improvements and ef- ficiencies in care that were not feasible in fee-for-service, she says.
Ms. Yukon acknowledges some “hiccups” in the early days
of the rollout that resulted in payment delays for physicians as the company underwent a system change at the same time it took on South Texas. “But I think we have gotten over a vast majority of those things, and we are pretty stable at this point,” she said. United also worked with TMA to address physician complaints directly, she says. Plans report quarterly on their performance, and “the real- ity is if a metric is 98 percent and we are at 97.8 percent, we will get fined. So provider protections are very much already on the books, and HHSC is diligent in its oversight of us,” Ms. Yukon said. Still, United is attuned to the concerns raised dur- ing the legislative session and is open to changes to help make physicians’ lives easier. In fact, lawmakers established advisory workgroups par- tially with that goal in mind. Among them, SB 7 revived a statewide Medicaid Managed
Care Advisory Committee to address systemic HMO issues af- fecting patients and physicians — a key workgroup that TMA leaders look to as another advocacy vehicle for how to better the program and establish some best practices. The committee will address a range of issues, including program design and benefits; systemic concerns from consumers, physicians, and providers; efficiency and quality of services; contract require- ments; network adequacy; and trends in claims processing. SB 7 also reauthorizes and expands the work of the 2011 Quality-Based Payment Advisory Committee, on which TMA already serves, to help develop quality metrics for Medicaid HMOs to use in novel payment initiatives. SB 7 and SB 58 collectively set up several other workgroups:
• The STAR Kids Advisory Committee will guide HHSC in de- veloping the new HMO model for children with disabilities.
• The Intellectual and Developmental Disability System Re- design Advisory Committee will provide input to HHSC and the Department of Aging and Disability Services on the new HMO model for adults with intellectual and developmental disabilities.
• The STAR+PLUS Quality Council will guide HHSC on how to improve quality, patient-centered care in the STAR+PLUS HMO model for patients with physical disabilities and for seniors.
October 2013 TEXAS MEDICINE 21
• The Behavioral Health Integration Advisory Committee will address the integration of physical and mental health care services into Medicaid managed care.
TMA nominated physicians to serve on all of these commit-
tees. At press time, HHSC had not yet named the committee members. n
Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by tele- phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
All articles in Texas Medicine that mention Texas Medical Association’s stance on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. That law requires disclosure of the name and address of the person who contracts with the printer to publish the legislative advertising in Texas Medicine: Louis J. Goodman, PhD, Executive Vice President, TMA, 401 W. 15th St., Austin, TX 78701.
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