KanCare Contractors Say Most Problems Are Now Fixed

Chief executives with the managed care companies charged with running the state’s Medicaid program on Friday assured a legislative oversight committee that they’ve fixed most of the new system’s operational problems.

“We feel very good about our performance,” said Tim Spilker, health plan chief executive officer with UnitedHealthcare. Testifying during a meeting of the Robert G. Bethell Joint Committee on Home and Community Based Services and KanCare Oversight, Spilker said consumer satisfaction surveys and claims and payment data show that the company is meeting national performance standards.

“We’re at about the NCQA (National Committee for Quality Assurance) average for performance,” he said. “But we don’t want to be average; we want to be best in class.”

Also testifying were Laura Hopkins, CEO with Amerigroup Kansas Plan, and Michael McKinney, M.D., CEO and plan president with Sunflower State Health Plan. The three for-profit companies have been running the state’s $3 billion Medicaid program known as KanCare since January 2013. Gov. Sam Brownback proposed and legislators agreed to privatize the program in an effort to improve health care outcomes and lower the system’s costs by $1 billion in five years.

McKinney, Hopkins and Spilker each said their companies had spent much of the past year responding to problems as providers adjusted to new billing forms, procedures and prior-authorization requirements. “Computers don’t think, they just look,” McKinney said. “If you send me a bill for somebody who’s my patient and I haven’t been notified or if they’re not on my list (of patients), the computer is not going to pay it.”

Amerigroup, McKinney said, has spent considerable time and money getting its computer system to remind its workers when people receiving in-home services or living nursing homes need to have their plans of care reviewed. He said that for several months last year, tardy reviews weren’t recognized by the computer and subsequently were rejected, delaying provider payments. The three executives each said their companies’ data show “clean claims” being paid within one to two weeks of their receipt, and most prior authorization requests being answered within two weeks.

Rep. Barbara Ballard, a Democrat from Lawrence, asked the three executives to rate their respective companies’ current performance levels on a scale of one to 10. Spilker and McKinney said eight, Hopkins said “in the eight to nine range.” Ballard said she’d noticed that those who’d had concerns about KanCare in the past “aren’t complaining as much now.” Rep. Willie Dove, a Republican from Bonner Springs, asked if anyone in the audience — a mix of about 40 consumer advocates, lobbyists and state officials — wanted to call the committee’s attention to problems with KanCare. No one did.

McKinney, Hopkins and Spilker each said starting “health homes” for people with serious mental illnesses had resulted in fewer hospitalizations and emergency room visits. They also said they looked forward to working with legislators on a bill that would establish a behavioral health drug formulary. The bill, which is opposed by mental health advocates and the state’s pharmaceutical lobby, has yet to be introduced. Sen. Mary Pilcher-Cook, a Shawnee Republican and chair of the committee, welcomed the executives’ testimony. “I’m encouraged,” she said. “I think KanCare is getting better and better all the time. It’s never going to be perfect, but we’re going to get it as perfect as we can.” The process for overseeing the managed care contracts, she said, appears to be working. “Is there a better process?” Pilcher-Cook said. “Maybe. But I think we need to keep the process that we have going and keep striving to be the best we can be.”

Sen. Marci Francisco, a Democrat from Lawrence, said she didn’t doubt that relations between the managed care companies and healthcare providers are better than they were six to nine months ago. “Their one-on-one relationships with the MCOs may be OK, but we’ve also made it so they’re having to deal with three different systems for handling Medicaid: three different sets of billing codes, three different submission patterns for billings. “Essentially, we asked them to do a lot more processing, which, I’m concerned, means they have fewer resources for providing services and care,” Francisco said. “They’re having to juggle three systems instead of one.”

The KHI News Service is an editorially independent initiative of the Kansas Health Institute.