I’m here in Sarasota, Florida today to release our new study looking at the quality of care for the approximately two million kids receiving health care services through Florida’s Medicaid managed care program. The study was commissioned by the Sarasota Herald-Tribune and supported by the Community Foundation of Sarasota County. We appreciate their wonderful partnership on this project – the care and concern for the community they operate in is evident and indeed for the children of Florida statewide. And while I am appreciating partners, a big shout out to my research assistant and co-author Jordan Messner for her terrific work on this project.
Given the tragic events that unfolded in Orlando just a few days ago, it was hard for me to turn my attention to our report. Then a friend reminded me of the need to keep focused on preventable harms even as we mourn the many lives lost or shattered in the violence. Medicaid covers an incredible 41.6% of children in Florida — including those with the lowest incomes, the greatest health care needs, and (disproportionately) children of color. Ensuring that these children receive high quality health care will improve their educational outcomes and economic prospects and, of course, their health. These kinds of long term, positive outcomes, are important to keep an eye on when moments of tragedy strike.
The vast majority of children in Medicaid in Florida – 95% — receive care through a managed care plan. This change in the delivery system took a decade to unfold – a process I have been watching closely since its inception as many of you know. Our report examines how Florida’s Medicaid managed care is performing for children using existing data sources on national pediatric quality indicators and based on a survey of pediatricians in Florida we conducted with the help of the Florida Chapter of the American Academy of Pediatrics. Let’s look at what we found:
National Pediatric Quality Indicators
As many of our readers know, states voluntarily report on a series of quality indicators for children in Medicaid and CHIP. Florida consistently reports more measures in the “Child Core Set” than the median state and deserves high marks for transparency and reporting. Unfortunately though, the results are not good. Only six out of ten infants in Florida received the recommended number of well-baby visits and the majority of adolescents in Florida did not receive their pediatrician-recommended annual well-child visits. My colleagues Tricia Brooks and Sarah Koslov have written an excellent longer report looking at how Florida stacks up on the Child Core Set.
We received responses from 131 pediatricians from around the state of Florida. This response rate of 6% is low, so our findings should not be considered generalizable. However, the majority of those responding had very high percentages of Medicaid patients in their practices – thus their responses represent the opinions of doctors who see large numbers of kids who are on Medicaid every single day. I think we need to take their concerns seriously.
Physicians reported a number of challenges with the managed care system, including enrollment issues. Two-thirds of physicians reported an increase in patients who had been reassigned to a new managed care plan or doctor without their knowledge.
The majority of physicians reported issues in access to care. Fifty-five percent of respondents said they had many cases where plan benefit limits or prior authorization requirements prevented them from providing necessary treatments. Access to medications was also seen as a concern. Eighty-four percent of responding physicians said their patients experienced difficulty accessing prescription or over-the-counter medications. In contrast, surveyed physicians did not consider wait times for visits to be a problem. Ninety-five percent reported that sick visits and well visits were available within the recommended guidelines.
Behavioral health referrals were noted as hardest to find. The majority of physicians reported that they had trouble finding a pediatric specialist that will accept Medicaid when referring a patient – although it is worth noting that one-third of respondents said they didn’t have a problem. While physicians said that similar problems existed for privately insured patients, two-thirds reported that Medicaid patients had more difficulty than privately insured patients in finding a specialist. By a wide margin, the specialists that were most frequently noted as challenging to find were behavioral/mental health professionals. While such a shortage may exist for privately-insured patients as well, given the higher prevalence of behavioral health problems for children receiving Medicaid, and the growing recognition of the need to address these issues early on, this is a major area of concern.
Although a few surveyed physicians thought that Medicaid managed care was working well for children, most believed that the move to managed care has led to worse care for their Medicaid patients. You can read more about our findings here.
Our findings suggest that Florida has considerable room for improvement in its much publicized move to managed care. The state’s obligation to its youngest citizens as well as the need to ensure that public dollars are being well spent coincide here. Stricter oversight of Florida’s managed care plans and tightened contractual obligations are needed to ensure that kids get the care they need.
(You can watch a video of the public forum hosted by the Sarasota Herald-Tribune and Community Foundation of Sarasota County here.)