Over a million poor Georgians get their medical needs met through Medicaid. This year the state hopes to save $80 million by switching to managed care. That means doctors and hospitals won't be paid directly by the state, but will have to contract with one of three companies the state has selected. In turn, those companies have to build a network of medical professionals that will see their members. Michael Cotton is the CEO of Wellcare, which operates statewide. He says it's been hard to build a network, especially in rural areas.
"I think the issue in some of the regions is that there's not been managed care in any form in the marketplace - managed care in terms of HMOs and what we call 'primary care assignments.' So some of that is part of the challenge. I think once we've had a chance to communicate what the program is, attaching members to providers, making sure that patients have access, and there's an understanding of that as the goal of the program, we think we do a much better job in terms of getting providers to understand and attracting them to the plan."
Cotton says Wellcare is still negotiating with major hospitals in south Georgia, but he hopes that by September 1st they will see the patients that select his plan.
Another struggle for the managed care companies is the fact that some doctors, mainly specialists, have decided to completely quit seeing Medicaid patients because the payout isn't that good. Craig Bass is the CEO of Amerigroup, which will roll out September 1st in southeast, east, and north Georgia. He says he keeps talking with doctors.
"But I do think physicians are taking this opportunity to re-evaluate what they do and don't do relative to their business. They have to pay their bills just as much as everybody else does."
One company that says it has a full network of hospitals and primary care physicians is Peachstate Health Plan which will operate in southwest Georgia around Albany, Tifton, and Valdosta. It's CEO, David McNichols, says their plan is as good as the former state Medicaid system.
"The issue for us is the same issue that the state has faced historically, and that is there simply are not enough specialist providers down there. So our network is as robust as the state had prior to, or today, before going to managed care, we have as good or better coverage. But candidly, there just are not enough docs."
Earlier this month, a group of doctors in Atlanta where all three companies have been operating since June first sued them, saying they were holding back claims and keeping the money as long as possible to earn interest. But Craig Bass of Amerigroup says those allegations are not valid.
"We're off to a very solid start. We are paying 99% of our claims within 15 business days of the claims that we've received, and I think that many providers are working with us to make sure that they get their claims processed. And our intention is that the providers get paid for the services that they provide to our members."
State officials blame a lot of the problems to the massive shift of how medical care will be provided to Georgia's poor from now on.
It's not only doctors who see the change, but patients as well. Michael Cotton with Wellcare says that they will have to educate their new members, that they have to see a doctor or call a nurse as the first step in healthcare.
"This is a population that has routinely used emergency rooms for primary care services, so we believe education, outreach are very critical, very important, and we've made that a cornerstone to our program."
The glitches that still exist in the system changeover have caused at least one lawmaker to ask the state to change the deadline for the statewide rollout of managed care for Medicaid from September 1st to October 1st.
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