They often say the best predictor of future behavior is what we have done in the past. As the Legislature is examining how best to integrate physical health care with behavioral health care within the Medicaid/publicly-funded system, the current proposed language is pointing to the Medicaid Health Plans as the best solution. But this must be considered carefully.
A representative of the Michigan Association of Health Plans recently said he “believes it’s in the best interest of patients and state taxpayers to proceed with at least some pilots to show whether better managed care can provide better outcomes.”
Before this legislation was even proposed, Michigan has been running a pilot in four regions for dual Medicaid-Medicare enrollees. People were automatically enrolled in Medicaid Health Plan-like entities, with the option to subsequently leave. Ironically, after two years, over 60 percent of these participants thought it was in their best interest to de-enroll from them.
The best place to evaluate outcomes would be the Medicaid Health Plans current performance in the 2016 HEDIS Aggregate Report for Michigan Medicaid. Across the board, it would appear they are falling short on the first claim. Of the 63 health measures reported to the government, 37 percent of them fell below the national Medicaid 50th percentile.
Within the 63, there are only a couple integrated health indicator rates measured. Again, their performance falls short. For both “Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia” and “Adherence to Antipsychotic Medications for Individuals with Schizophrenia” the Medicaid Health Plans ranked below the national Medicaid 50th percentile.
One legislator said, “We need a pilot to see how it works with mind and body. ... It is very expensive now, and costs are rising. We don’t want the system to be more expensive with the same results.” A worthy argument for any public official wanting to show taxpayers fiscally responsibility with state and federal monies.
From 2013 to 2015, the Medicaid Health Plans had a 627 percent increase in profits. According to Allan Baumgarten, the Minneapolis-based consultant who publishes the annual report, 2015 saw a record profit of $330.7 million; a 2 percent margin.
Additionally, the Medicaid Health Plans provide care with a 17 percent administrative cost; contrasted against the 7 percent administrative cost reported in Michigan current behavioral health system.
To achieve an advantage for Michigan taxpayers would come at a steep cost. The public behavioral health system runs $2.6 billion. If the Medicaid Health Plans take over, $260 million would be lost to the higher administrative costs. It is reasonable to also assume a 2 percent profit margin would take another $52 million. Therefore, Medicaid Health Plans would need to find more than $312 million of savings for them to stay whole, yet ensure behavioral health services are not reduced for Michigan’s most vulnerable citizens.
There is no strong evidence of a substantial economic impact for integrated care. In a 2014 Policy Summary, 19 economic studies were reviewed. One of its key messages was that the reporting of cost-savings measures was inconsistent and the quality of the evidence was often low.
On Behalf of REAL Michigan and other advocates for substance use and mental health services, we ask that the legislators give strong heed to the thousands of citizens and health care experts who spoke out during the 298 Work Group process.
We ask that they act to protect the true best interests of Michigan’s residents and make an informed choice regarding the current proposal to place the Medicaid/publicly-funded behavioral healthcare system into private hands.
Deborah Garrett is director of recovery communication for REAL MI.