In an impromptu meeting with reporters Monday, Gov. Paul LePage said he didn’t support the idea of using managed care organizations as a way of lowering the cost of health care in Maine, saying quality of care would decline along with cost to the state..
Though word has not come out officially, several parties with knowledge of negotiations say managed care is a cornerstone of an amendment being hammered out by Assistant Senate Minority Leader Roger Katz, R-Augusta, in an effort to win GOP support for Medicaid expansion, the Democrats No. 1 priority during this short Legislative session.
Managed Care Organizations are third-party groups contracted by the state to administer Medicaid services. The idea is that they are paid a set amount of money per patient served, not per procedure. This creates an incentive to reduce the amount of unnecessary procedures by incentivising targeted preventive care. The MCOs are held accountable for quality of care and health outcomes, which is meant to prevent them from denying payment for necessary procedures just to save a buck.
LePage said he used to support managed care, but has since learned that promised savings never materialize. He also said he’s talked with Katz about the plan, but is unconvinced that MCOs are any different from the health management organizations that used to be part of Maine’s Medicaid landscape. LePage said those groups do little to drive down costs or improve the quality of care.
“When I asked Roger about that, his response was, ‘Well, that was the old HMOs. They’ve gotten better,” LePage said. “OK, if they’ve gotten better, Roger, explain to me what’s gotten better? Because I’ve seen HMOs and I’ve met with these managed care companies. Tell me what I’m missing. I’m still waiting [for a response.]”
LePage said he thinks a better model are Accountable Care Organizations, which put the onus for lowering cost and improving service on the practitioners and care providers themselves, rather than a third party. Under that system, LePage said, a hospital or other provider is given a predetermined amount of money to service a certain Medicaid population. If the provider can save money over the previous year, they get to keep half the difference.
The governor said he’s seen the ACO model work in other states, and is working with Health and Human Services Commissioner Mary Mayhew to find ways to incorporate the model in Maine.
“That’s the only [model] I’ve seen that saves everyone money and improves the quality of care,” he said.
In the meeting with reporters, LePage also reiterated his position that Maine should invest in care for its mentally and physically disabled, homeless and elderly population rather than committing to pay any future costs associated with expanding Medicaid to anyone — disabled, elderly or otherwise — who makes less than 138 percent of the federal poverty level, as would be done if the state accepts federal money under the Affordable Care Act.
For that reason, the governor’s opinion on managed care organizations may be a moot point. Lawmakers long ago realized that if Medicaid expansion is going to happen, it will be over the governor’s objections. That’s why so much effort is being focused behind the scenes to come up with a compromise that will win enough GOP support for Democrats to override a near-certain gubernatorial veto.
As we reported last week, that effort is being bolstered by advocacy groups representing Maine’s hospitals, doctors and business owners, who are pressuring lawmakers to come up with a compromise.
For now, everyone involved in those conversations is staying pretty quiet.