A recent report from the Florida Agency for Health Care Administration focuses on potentially preventable emergency room visits and hospital admissions to help answer the question, “What are we getting for our money?”
Recent news has been dominated by Congressional proposals to radically restructure Medicaid financing. Public discussion surrounding Medicaid has shed light on some stereotypes and misinformation. Medicaid is already highly cost-efficient and most Medicaid beneficiaries are satisfied with their care and have health outcomes comparable to those who are privately insured. This is particularly noteworthy since Medicaid disproportionately serves people in much poorer health with substantially fewer resources than those privately insured.
The agency’s report demonstrates the state’s valuable efforts to improve Medicaid quality of care as well as reduce costs. It focuses on “potentially preventable health care events (PPEs)” including hospital admissions, hospital readmissions and emergency department (ED) visits. The agency recognizes that, “although not all potentially PPEs can be avoided, PPE rates in populations can be used as a gauge regarding the failure to access primary care and the quality of care available.”
The report includes an analysis of managed care plan data from August 1, 2014 to July 31, 2015. Findings are broken out by age, eligibility groups, plans and regions. Here are a few highlights:
Out of the state’s $26.4 billion Medicaid budget, more than $15 billion is allocated for Medicaid managed care.Mostly private for- profit insurance companies are responsible for providing managed care to more than 3 million Florida Medicaid beneficiaries — primarily children — and thousands of beneficiaries with medically complex conditions.
The report is a terrific starting point for drilling down on the barriers beneficiaries face in trying to access needed care. But fundamental questions remain, such as:
The stage is set for critically important follow-up work, including direct engagement of beneficiaries, providers and plans. We commend the agency for taking this evidence-based, common sense approach to improving health care for the most vulnerable Floridians.