Opinion: Eliminating Provider and Clinic Choice Causes Unnecessary Harm and Disruption to Medicaid Patients

Imagine that you’ve been going to the same doctor and clinic for many years. You have great relationships with them, and they help you manage some chronic health conditions and ongoing mental health concerns. Now imagine that choice to continue seeing this provider has been taken away. You’d likely feel anxiety about finding another clinic that will meet your needs, worry about how a transition will affect your care, and anger about not being able to keep your provider of choice.

This scenario is exactly what Medicaid patients in North Central Washington have experienced over the last several months, after the Health Care Authority (HCA) reduced the number of plans serving those patients in the region, as it moved toward Integrated Managed Care (IMC). For many patients, this meant having to change their health plan, which also meant having to change their clinic and providers. This scenario is a looming probability for 1.6 million more Medicaid patients in eight regions across the state, as those regions transition to Integrated Managed Care over the next two years, stripping control from Medicaid patients over this fundamental choice in their health care.

The goal of Integrated Managed Care is to provide a whole person system of care, integrating behavioral health services with medical care. As regions transition to Integrated Managed Care, HCA intends to reduce the number of health plans serving Medicaid enrollees for the sake of administrative ease. This is counterproductive. It would mean that thousands of patients would be assigned to new health plans, disrupting vulnerable patients’ continuity of care and taking away their ability to choose their own providers and clinics.

To ensure that patients can maintain their provider or clinic of choice, we are urging the Legislature to ensure that the existing five contracted health plans that meet certain minimum standards are able to continue serving patients in regions transitioning to Integrated Managed Care.

Being re-assigned to a health plan could disrupt patient continuity in a number of ways. If their newly assigned health plan doesn’t contract with their current providers, patients will be forced to switch from often long-standing, trusted provider relationships (less than 1% of Medicaid enrollees choose to change their plans.) Maintaining a relationship with their primary care provider or clinic in their own community is essential to promoting health and supporting a whole person approach to care.

In rural areas, switching providers could mean increased travel time and transportation challenges for patients. It could interfere with additional and critical support that vulnerable patients receive through their Managed Care Organization’s care management programs. And it could disrupt pre-authorized specialty appointments and surgeries. It also creates problems for patients who move across regions.

We have North Central Washington as a real example of the disruption this decision creates. Moses Lake Community Health Center has been in the thick of this transition and seen firsthand its negative impact on their patients.

According to Moses Lake Community Health Center CEO, Sheila Chilson, “When our patients were informed that they must change their health plan, many were frustrated, uncertain, fearful, confused, and angry.” Supporting patients through this transition has taken a huge toll on the health center, requiring significant staff overtime and diverting precious resources to help patients through their health plan change.

The change has caused delays in necessary tests and treatments and resulted in a 10% drop in prescriptions being filled by Moses Lake’s patients. Staff report patients waiting days without their needed prescriptions.

The re-assignment in this small region also generated assignment errors for roughly 2,600 patients, including multiple enrollment letters and different plans among family members. These system errors created confusion and extra work for patients and providers to correct. In larger regions such errors could create more havoc.

If the goal of Integrated Managed Care is to achieve whole person care and improved health, then patient experience and impact should drive policy decisions. And that should make it easy for legislators to prioritize Medicaid patients being able to choose and maintain their providers, clinics, and health plan in every region of the state.

Leanne Berge is CEO of the Community Health Network of Washington and Community Health Plan of Washington. Bob Marsalli is CEO of the Washington Association of Community & Migrant Health Centers.