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Bentley to update plan to reform Medicaid in Alabama


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Bentley to update plan to reform Medicaid in Alabama

Gov. Robert Bentley will announce the first six organizations certified to provide managed care for specific regions of the state.

The Legislature passed a law in 2013 to change from a system that pays doctors and hospitals for each procedure and service to one that allots regional care organizations a set amount per month to manage the health of Medicaid recipients.

Continue reading here: http://www.al.com/ne...o_update_p.html

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What a joke ... Bentley continues to make a mockery of the state's approach to healthcare.

One of the commentors from the original al.com article nails it ...

So the way to lower costs is to simply restrict it to "first come, first served". Regardless of need. Allot so much to each office, and when the money is gone, it is gone.

This is a shell game to mask the screaming need for assistance to our poor, by burying the cost in new layers of bureaucracy. And then say to the folks in need "sorry, but your regional office has already used up its allotted amounts".

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What a joke ... Bentley continues to make a mockery of the state's approach to healthcare.

One of the commentors from the original al.com article nails it ...

So the way to lower costs is to simply restrict it to "first come, first served". Regardless of need. Allot so much to each office, and when the money is gone, it is gone.

This is a shell game to mask the screaming need for assistance to our poor, by burying the cost in new layers of bureaucracy. And then say to the folks in need "sorry, but your regional office has already used up its allotted amounts".

No, it doesn't nail it at all. That person appears to have no idea how this works.

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I am short on time and still learning all the details but here is a quick explanation based on what I have gathered from those with real knowledge of this.

It will be sort of similar to the Medicare Advantage plans regarding who has the risk. Advantage plans take on the risk instead of Medicare (government). You never hear of Medicare Advantage members being turned away because the "money is gone." This change takes the risk off the state and puts it with the RCO. The RCO will be an organized group of physicians, hospitals and other providers of Medicaid services in a group of counties in the state. It will reduce the Medicaid expenditures. The RCOs will not be insurance companies. This will move us away from a fee for service to a capitated payment per member or "at risk" contract. For those electing to enter into a "risk-reward" contract with an RCO, the "risk" is the capitated payment per member. If quality care is provided to patients for less than the capitated amount, those participating as at-risks physicians will share in the "reward" of those savings. If the cost of care exceeds the capitated amount, the RCO's reserve (part of the solvency requirements to become a RCO) can be accessed to cover the cost of that care. There will be oversight similar to Medicare and the Star Ratings which takes into account quality, cost and outcomes.

There is no scenario where we "run out of allotments".

My OPINION is that this is a precursor to Medicaid expansion because part of the extra money from that can help get this up and going. Not necessarily needed but would certainly help.

I'm sure I missed something or maybe even made it muddier to some but this is what I have learned so far.

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I guess I'm still stuck on how it's not possible to run out of money when admittedly these "organizations" will be provided a fixed amount of dollars ... also, hard to see how this makes anything more efficient ... you're adding more layers, no?

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The "running out of money" is on the RCO and not on Alabama. The RCO will have to operate within the capitated agreement. There are incentives to work efficiently and with quality while paying attention to outcomes. There are solvency requirements to even operate as an RCO similar to insurance companies' reserves. The risk is off of the state and the expense will be basically fixed for Medicaid claims.

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So the RCOs have to foot the bill of any shortage? Is that what your saying? What keeps them from stopping to provide or reducing coverage/care?

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So the RCOs have to foot the bill of any shortage? Is that what your saying? What keeps them from stopping to provide or reducing coverage/care?

Simply stated, yes on the shortage. In regards to the second question, I don't have any hard proof but I assume there are stipulations in the RCO agreement that the providers can't turn any medicaid members away, etc. if they are part of a RCO.

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