Home Care Industry Offers Solutions to Managed Care Implementation Issues
Sep 21, 2012 | 1261 views | 0 0 comments | 5 5 recommendations | email to a friend | print

Solutions Will Ensure Improved Access  

to Quality, Affordable Home Care Services for Texans


AUSTIN, TX - The Texas House Human Services Committee heard testimony today from health care experts, state officials and industry stakeholders on the current state of managed care implementation in South Texas.     


Texas Association for Home Care & Hospice (TAHC&H) executive director Rachel Hammon, BSN, RN, addressed several challenges with the implementation of the new system that threaten access to quality, affordable care for Texans who receive these services.      


"The home is fast becoming the first choice of health care among elderly, disabled and medically frail Texans and is the most cost-effective method of care for Medicare and Medicaid," said Hammon. "Improving the implementation of Texas' managed care system is essential to ensure continued access to quality and affordable home care services for Texans."


Among the issues that Hammon addressed were poor communication by managed care organizations (MCOs) to home care service providers and insufficient accountability, transparency and quality of care processes for MCOs. (MCOs are private companies who contract with the state and home care providers to assist in the delivery of home care services.)


Hammon cited the consequences of Molina Healthcare's - a MCO serving thousands of Texans across the state - recent announcement to cut reimbursement rates as an example of the importance of adequate state oversight and a robust quality measurement system for MCOs. Since announcing its intent to reduce all reimbursement rates by 10 percent in June 2012, approximately 11,000 individuals have dis-enrolled from Molina statewide as of August 2012, according to Texas Health and Human Services Commission (HHSC) data. This includes 7,400 just in the Hidalgo (south Texas) service area alone. In South Texas, only two additional MCOs are available to take patients who choose to switch, and in El Paso, enrollment is only available in one other MCO.


"We are already seeing the ripple effects of Molina's actions, including challenges facing other MCOs to meet the needs of the large influx of new beneficiaries in their area," said Hammon. "The result is threatened access to care for Texans who rely on these services."    


Hammon praised the steps taken thus far to improve these issues, and urged the committee to work with HHSC and other industry stakeholders to implement solutions that will benefit providers and patients.  


Hammon offered several solutions for the committee to consider, including:

  • Continued conversations between HHSC, industry participants and other stakeholders to ensure issues are quickly identified, prioritized and resolved so that providers can focus on caring for their patients;
  • Transparency on all administration levels - including HHSC, MCOs and providers - to promote open discussions about improving the quality of care;  
  • Sufficient tools for HHSC to act as an effective contract manager, including adequate state oversight with clear contractual guidance to MCOs on expectations, responsibilities and meaningful quality measures developed using experiential data; and
  • Proactive measures to assess performance of MCOs using ongoing feedback from patients and providers.

"We commend HHSC and other industry stakeholders who have been dedicated to finding and implementing solutions for Texas' Medicaid managed care program," said Hammon.  "We look forward to continuing to work with lawmakers, HHSC and other stakeholders to address these issues and identify solutions that will benefit providers, MCOs and the patients they serve."




The Texas Association for Home Care & Hospice Inc. is a statewide nonprofit trade organization whose mission is to advocate for ethical practices, quality and economic viability of licensed providers of home and community support services in Texas.  For more information, visit www.tahch.org.


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