Executive Council May Slow Down Managed Care

The Executive Council is scheduled to vote Wednesday on a new Medicaid contract worth an estimated $2.2 billion dollars.

It is believed to be the largest contract in state history.

But signs from an Executive Council meeting today suggest that vote may be pushed back.

The state may struggle to meet its July 1stdeadline.

Dan Gorenstein: This Medicaid contract is huge.

It’s huge financially, handing over several billion dollars to three managed care companies to run the state’s Medicaid program.  

It’s huge for the some 140,000 New Hampshire residents who rely on Medicaid.

And Health and Human Services Commissioner Nick Toumpas says it’s a huge policy shift, too.

Toumpas: “What we are doing is we are engaging these organizations to help us administer the program because they bring a set of perspectives, techniques that we do not have at our disposal.”

Gorenstein: Here’s the state’s starting point.

They don’t want to do anything to compromise Medicaid services.

They also want to save money.

How do you do both?

Help Medicaid patients use the healthcare system in more efficient ways.

Specifically, Toumpas said the managed care companies – Centene, Meridian, and Boston Medical Center Health Plan – will make sure Medicaid patients find their way to primary care doctors.

The problem right now, Toumpas told Executive Councilors, is that the patients get lost in the complicated healthcare system...and that costs money.

Toumpas: “Right now they will wander around, I mean no disrespect to that, because they have no foundation, a trusted entity to navigate a complex system. That’s the key first step that needs to happen. Is it a change? It’s a big change.”

Gorenstein: While some finer policy points may have been lost on the Executive Councilors, the fact that managed care is a massive change hit home.

One councilor raised the idea of tabling the matter.

The proposed contracts were released publicly on Friday and total well over 1000 pages.

Given that, Deb Fournier with the New Hampshire Fiscal Policy Institute says slowing down makes some sense.

Fournier: “The breadth of the documents, the scope is so huge...it requires a little bit of time to examine them carefully and thoughtfully.”

Gorenstein: Fournier says the best chance to realize the $16 million dollars in savings earmarked in the budget, is to give healthcare providers time to paw through the contracts.

She says the more providers the state and the managed care companies are on the same page, the easier it will be to streamline the system.

It looks like the Executive Council agrees more time is needed.

But some fear missing the deadline would make it hard for the state to save money.