WSMA WEIGHS IN ON CHANGES TO MEDICAID MARKETPLACE

In this week’s “Monday Memo,” Tom Curry of the Washington State Medical Association addresses the spreading awareness of the coming change in Medicaid plan activity, which we reported on here a few weeks back.

His editorial comments followed a two paragraph explanation of the RFP process.  Though brief, they are telling for a couple of very interesting reasons.

Questions: can local health plans compete with national behemoths on increasingly low-margin state Medicaid programs? What will be the impact on physicians and medical groups wishing to – or having to, thanks to demographics in their service areas – serve this population?  For-profit, not-for-profit, local or national distinctions don’t seem nearly as important as the administrative impact of the plans’ relationship with the medical group. Administrative simplification trumps the other considerations.

The two take aways I glean from this short piece are:

1.  An increasingly prevalent conversation is taking place about the roll of national for-profit plans entering the market.  In part, this is driven by local plans using the angle as a wedge issue.  After all, Molina, a for-profit, national plan already dominates the Washington marketplace.  And, national plans have yet to fully engage the conversation until after the RFP results are announced later in January.  Nevertheless, the anxiety caused by this shift is real and extends throughout the Medicaid marketplace players with which I’ve spoken in recent weeks.

2.  For all of the talk about the change in Medicaid plans, what matters most to physicians is how easy it is to interact with the plan.  The final comment, “Administrative simplification trumps the other considerations,” is key in that regard and cannot be stressed enough.  The per practice cost to file claims is extraordinarily high, averaging in Washington to be about 1 FTE per 3 physicians (sometimes worse).  From the physician perspective, the plan that facilitates and strengthens the patient-physician relationship is one that will find the greatest physician support, regardless of where the plan profits go.