Health Care

Group rates Florida’s Medicaid HMOs average, but state lauds quality of care

Secretary of Florida's Agency for Health Care Administration, Elizabeth Dudek, said “Medicaid recipients enrolled in Managed Medical Assistance plans now have access to the highest quality of care in the history of the Florida Medicaid program.”
Secretary of Florida's Agency for Health Care Administration, Elizabeth Dudek, said “Medicaid recipients enrolled in Managed Medical Assistance plans now have access to the highest quality of care in the history of the Florida Medicaid program.”

Most of the private companies managing Florida’s Medicaid health insurance program for low-income people ranked at the national average on patient satisfaction, preventive care and medical treatment in 2014, according to a recently released comparative rating of plans.

But the ratings excluded six of the 13 private insurers in Florida’s Medicaid program during 2014 because those health plans either failed to report data or submitted insufficient information to the National Committee for Quality Assurance, a nonprofit that rates and accredits health plans.

The NCQA’s seal is considered the gold standard for measuring health plan performance. Yet of the six Medicaid insurers not ranked for 2014, five lacked full accreditation from the organization.

This year, only two of those unranked insurers are still doing business with Florida’s Medicaid program: Prestige Health Choice and Simply Healthcare Plans, both of which offer coverage in Miami-Dade. The other four plans were either sold or dropped out.

And of those Florida Medicaid insurers that were rated by the NCQA, none scored higher than 3.5 out of 5 possible points, reflecting average performance.

We want to get to a point where it’s Lake Wobegon and everyone is above average at everything.

Justin Senior, Florida Medicaid deputy director

But the state’s Agency for Health Care Administration doesn’t see it that way. Instead, the agency trumpeted a separate set of data this week as evidence that the state’s transition to a mostly private model for Medicaid is improving health outcomes and increasing access for the estimated 3 million Floridians in the system.

“Medicaid recipients enrolled in Managed Medical Assistance plans now have access to the highest quality of care in the history of the Florida Medicaid program,” said Elizabeth Dudek, AHCA secretary, in a written statement.

Dudek’s statement was based on 51 quality metrics reported by Medicaid health plans, including adherence with check ups and immunizations, the level of follow-up care for certain types of patients, frequency of prenatal care and other information.

The metrics are collectively known as the Health Effectiveness Data and Information Set or HEDIS, and they are used by nearly all health plans to measure quality of care.

The NCQA’s ratings, on the other hand, are derived using HEDIS, consumer surveys, accreditation status and other information.

Using only HEDIS data, AHCA compared 2014 scores to the national average, and to scores for Florida’s Medicaid program in 2013, prior to the statewide roll out of Medicaid managed care.

Florida-Medicaid-HEDIS-2014-(1)

Justin Senior, Florida’s deputy secretary for Medicaid, said the 2014 HEDIS scores reflect significant improvements in care over the prior year. In 2014, he said, Florida’s Medicaid insurers scored at the national average or higher on 65 percent of HEDIS measures — compared to about 43 percent in 2013.

He said the 2014 HEDIS scores will help AHCA set performance “baselines” for future years, and those Medicaid insurers that fall short will have to pay a financial penalty.

“We want to get to a point where it's Lake Wobegon,’’ he said, “and everyone is above average at everything.”

But some healthcare experts say Florida needs more experience with Medicaid managed care before the state can draw meaningful conclusions from the data.

Tricia Brooks, a senior fellow with Georgetown University’s Center for Children and Families, questioned how anyone could measure Medicaid managed care’s performance in 2014 when the program did not roll out statewide until August of that year.

“It will not be possible to get a clear sense of how Medicaid managed care enrollees are faring until some time in 2016, when calendar year 2015 data is available,” she said.

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