OK- Proposed Medicaid solution in legislation aims to improve efficiency and outcomes

[MM Curator Summary]: The state is now going with a provider-led entity model to bring managed care back (maybe).


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Measures to create a system for managing Oklahoma’s Medicaid program in-state authored by Rep. Marcus McEntire, R-Duncan, and Sen. Greg McCortney, R-Ada, are headed for discussion in conference committee. (Photo by Alexandr Podvalny via Unsplash)

OKLAHOMA CITY – After the courts put an end to Gov. Kevin Stitt’s plan to privatize much of the state’s Medicaid program last year, it was left to lawmakers to come up with an alternative solution – one that would improve efficiencies and outcomes while keeping administrative dollars in-state.

Rep. Marcus McEntire, R-Duncan, and Sen. Greg McCortney, R-Ada, are authors on legislation intended to do that. The measures have some additional hurdles to clear before they can be implemented, however, and are sure to be intensely “cussed and discussed,” as McEntire put it, during the last few weeks of the legislative session.

McEntire recently told lawmakers on the floor of the House of Representatives claimed the plan lawmakers are working on could reverse the trend of the last few years and help rural hospitals reopen, or resume providing obstetrics care.

“Every hospital, rural or urban, will be profitable again on their Medicaid clientele since the first time since the ACA (Affordable Care Act) was passed,” McEntire told lawmakers when the bills came before the full House of Representatives on April 28. “And we’re talking real money here, that they’re going to be able to reinvest in their communities.”

The plan gives lawmakers more control to continually tweak the program to address constituent needs, and to ensure that the healthcare companies involved are focused on efficiently spending Medicaid dollars to get the best health outcomes for patients.

After voters approved State Question 802 in 2020, expanding Medicaid, lawmakers set about figuring out a way to pay for it and make sure the program was administered efficiently. Stitt pushed for managed care, having the Oklahoma Health Care Authority award roughly $6 billion in contracts to a handful of national insurance companies.

The Oklahoma Supreme Court struck down that deal, finding OHCA did not have the legislative approval to move forward with the managed care plan, and the expansion approved by voters did not authorize such a program.

Oklahoma last attempted managed care in the 1990s, but amended the plan after seeing a precipitous decline in participating physicians, resulting in scarcity of care.

Oklahoma-based companies would better implement the state’s Medicaid program, and lawmakers should monitor progress to ensure that the funding they receive is concentrated in providing healthcare services rather than boosting profits, McEntire said. The proposed plan would encourage provider-led entities such as Integris to expand their accountable care organizations statewide, and those Oklahoma-based organizations would likely partner with larger, national companies to provide financial backing, he said.

“This plan puts an Oklahoma provider-led entity in the middle of that,” McEntire said. “The money will stop there in state. There is no doubt these provider led entities do not have the financial reserves to take on this much risk; they will need somebody financially backing them…

“If they overshoot those capitated amounts they’re going to need an insurance company behind them with the financial reserves to come in and bail them out because the state is not going to,” McEntire said.

The plan shifts the Medicaid program from a fee-for-service model to a value-based system, providing bonuses for improved outcomes and encouraging providers to take a more holistic approach to care.

Plus, the state would be able to leverage federal dollars to make sweeping change while keeping the cost of the program “net revenue neutral” for the state, McEntire said.

The measures were introduced as amendments on the House floor, introducing a lot of new language late in the legislative process. Though the measures were approved with overwhelming support in the House, the amendments were rejected by the Senate on May 5, sending the bills into discussions in conference committees over the next few weeks.


Clipped from: https://journalrecord.com/2022/05/09/proposed-medicaid-solution-in-legislation-aims-to-improve-efficiency-and-outcomes/