Stillwater Medical CEO Denise Webber doesn’t think managed care would be a good idea.
She doesn’t like it for hospitals, physicians or patients.
Managed care is the privatization of administering the state’s Medicaid program, which will soon be expanded to include close to 200,000 more people in Oklahoma. Gov. Kevin Stitt and the Oklahoma Health Care Authority introduced a plan last summer that would create the SoonerSelect Medicaid plan, and has already selected a handful of companies to manage it. That is being challenged by state lawmakers, who were left out of the process in June.
Webber believes the Medicaid expansion could still be handled by the OHCA.
“(Medicaid) takes care of our Oklahomans and folks that live in Stillwater. Usually it’s young women and children, that’s the majority on Medicaid. There are some that are ABD – aged, blind, disabled – but the majority of them are young mothers and young children that make very little and can’t afford to buy insurance. The state office, OHCA, manages that entire population currently. The state employs care navigators to help manage that population, to make sure there’s care coordination. There’s all sorts of rules that we currently have to follow to get paid. The population is already managed,” she said. “Managed care, in a sense, is you pay somebody a set fee, if they provide a lot of care or a little care to a population they get the same payment. The whole managed thing is kind of interesting that they’re saying that the care management will be different because there’s nothing in that RFP (Request For Proposal) that will be different than what they have today.”
Webber talked about how people in her field were against sending money to for-profit insurance agencies, but their reasoning is led by fewer of those tax dollars going to patient care.
“These are tax dollars that are supposed to be going to take care of part of our state’s population that truly needs it and we’re going to take anywhere from $250 million to $450 million and it’s going to turn into profit for these insurance companies instead of going into care. How they do that is by limiting services,” she said. “In the plan they’ve submitted to the state, they plan to reduce services by 40 percent, mental health services by 20 percent and they do that by denying, or won’t pre-certify a visit. They’ll ration care to a population of people that probably don’t have access to as much care as you need. If you expand the population, it’s just more of the same. What expansion does is allow more people to qualify for Medicaid. It just means those new people that will now qualify for Medicaid will get less care.”
Stitt argues that the care and benefits to patients will actually increase under managed care. He continues to cite Oklahoma’s low nationwide health rankings, against his election promises of making Oklahoma a Top-10 state.
Earlier this year OHCA CEO Kevin Corbett said because of the state’s fee-for-service system, Oklahoma “ranks among the worst in the nation in health outcomes and we’re not getting any better.”
“Moving to managed care in Oklahoma is important, so we can improve health outcomes and reduce costs,” he said.
Webber said Oklahoma should be celebrating its Medicaid program.
“It’s one of the most efficiently run state programs in the nation,” she said. “Our administrative costs, you look at how much of the $2 billion that’s given to OHCA is going to direct care for patients versus administration, ours is only 4 percent of an overhead cost. In these insurance companies’ proposals, they want up to 15 percent to pay for administrative costs.”
She worries that doctors across the state could end up opting out under managed care.
“What ends up happening – this is what happened in the '90s when the state did this – the physicians said ‘no thank you’ because the insurance companies are a pain to deal with. They play all sorts of games,” she said. “You play games in a commercial market. When I say games I mean the denials and the hoops you have to jump through. When it comes to a Medicaid dollar, for every dollar we charge, we may get 30 cents. There’s not a lot of ability to hire an army of people to put in all the things to follow all the rules. The physicians decide to self select out, and they say, ‘I don’t want to take Medicaid anymore.’ So then (patients) don’t have a network to go to. So pregnant moms show up at the ER when they need to deliver the baby, and that’s extremely dangerous. I can’t think of one good reason to do this, and I’ve thought long and hard about it because the government is so passionate about this. As far as doing things based off data and research, I’ve yet to find anything that says this is good for a state or their Medicaid enrollees.”
Webber said among the lessons that should have been learned from the pandemic is how hospitals need a system that works together, and anything that threatens rural hospitals threatens patients across the state.
“I don’t know what we would have done if we wouldn’t have had the rural hospitals in our state, because for the first time, in the pandemic, that I can recall, we were having to send people to smaller hospitals because we didn’t have room,” she said. “The large metros and even Stillwater Medical as more of a rural regional provider, there’s not enough capacity. That was true even before the pandemic. If all of the sudden all the rural hospitals are gone because they’re not financially solvent, we’re going to have build additional beds in metro facilities. Why does that make any sense?”
Managed care has also drawn concerted opposition from health associations. The Oklahoma State Medical Association filed an injunction against managed care with the Oklahoma Supreme Court earlier this year.
Stillwater physician Mary Clarke, now the president of the Oklahoma State Medical Association, said middlemen get in the way of the physician/patient relationship.
“Treatment decisions must be based on what is best for the patient, not the insurance company’s bottom line,” Clarke said. “To make things worse, the governor’s plan allows the insurance companies to auto-assign an insurance plan and doctor to the patient in some circumstances.”