Friday, August 19, 2011

Questions on Michigan "Dual Eligibles" Project from Stakeholders

This is from the Michigan Association of Community Mental Health Boards Executive Board and includes the complete list of questions from stakeholders mentioned in the last blogpost:

Integrated Care for Dual Eligible Beneficiaries in Michigan
The following is a list of Stakeholder questions and concerns as discussed at the MACMHB Executive Board Meeting August 5, 2011. Several forums were held in July offering the opportunity “to learn about and offer input into the state’s plans for integrated care for dual eligibles in Michigan”, however we were engaged late in the process and those who facilitated the regional meetings did not offer answers to our questions.

The questions pertain to three areas.

Changes to Consumer services and treatments:

  • Who makes the final decision as to which treatments and services are “inappropriate” and/or “too costly”?
  • Will Habilitative Services be continued to the extent necessary to maintain functioning level and skills and for how long?
  • Will Payers have the final approval over the PCP process and its content regardless of the individual beneficiary’s opinions?
  • Will the existing Supports Coordination system be continued and for how long?
  • What services will be available for those who “opt out”?
  • Has there been a real effort to ask Stakeholders for their opinions and what they want?
  • At what point will the CMHSP system no longer be used to deliver MI and DD services?
  • Will any real consideration be given to allowing regional health homes managed by CMHSP county partners?
Participating Payers:

  • Will anyone address the exorbitant reserves and extravagant Executive salaries and benefits of the large carriers?
  • Will anyone address the extreme administrative cost rates that result from these large executive employment packages and insure that Medicaid dollars will not be used to feed increases to these already high costs?
  • Would it not be worthwhile to compare the participating carrier administrative costs ratios with those of the present CMHSP system already serving these beneficiaries?
  • Since these Participating Payers have apparently been promised a share in any “cost saving” realized by the plan, what prevents them from gutting services and treatments in order to protect and insure they attain their share of the profits?
  • Assumed “Cost Savings” based on an improved treatment model for co-morbid conditions could take years before the individuals actually attain improved health and the system realizes the savings. What is the assumed source of additional funding in the interim? Will the Payers be required to use their reserves to cover this shortfall?
  • Has anyone questioned the logic and/or reasonableness of creating such huge monopolies charged with overseeing both commercial healthcare and tax payer funded Medicare/Medicaid dollars?
  • Who is responsibility for identifying fraud and abuse and what is the anticipated accountability process?
 DE Plan Governance Steering Committee:

  • Why is there no Stakeholder participation in this committee?
  • If the committee is charged with governance and oversight, it would follow that part of their responsibility is to insure the stated goals of improving healthcare and cutting costs are included in its charge. What happens when those two objectives are in conflict? Which of the goals
  • will take priority?
  • Decisions on or approval of treatment routines and service opportunities could not only alter the quality of life of these beneficiaries but also decide who lives or who does not. Who ultimately makes the final decisions for the most severe segment of this population?
  • Will the most severe therefore be determined too costly to support in any meaningful manner? This is one of the most important questions as these individuals are the most severely impaired, most challenging to treat, and are considered the least able to contribute to their healthcare costs and/or healthcare needs

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