Another view of legislative oversight

I wanted to take this opportunity to respond to an article entitled "Legislative oversight committee to be formed" that was published in the Fort Scott Tribune on March 23. While I applaud the legislature's attempt to get a handle on managed care, without subpoena powers, the oversight committee is left with little to no power. We have learned from the four states that have implemented managed care on people with intellectual disabilities that once an out-of-state insurance company has its foot in the door, there is no recourse for the people who have had their services reduced or the individual who is needing a medical procedure, but is denied.

We have received promises that there will be no cuts in benefits, no cuts in eligibility, no cuts in provider reimbursements and there will be improvements in care coordination. When this was mentioned at a national conference to providers from others states with managed care, they just laughed. They had received the same promises, yet cuts were made and services were not improved. It just added another layer of bureaucracy with money flowing out of state to large insurance companies. What is most troubling to me is that we have not learned any lessons from other states.

There is very little, if any support for managed care except for a few officials within the Brownback administration and the Tea Party. In order to sell managed care to the general public and legislature, they have had to utilize flawed data. This has been pointed out to the administration on numerous occasions, but they continue to use this data.

According to the spokesperson for governor Brownback, the cost to provide Medicaid services for persons with intellectual disabilities continues to rise. That is not the case. A longitudinal study of intellectual disability service costs across the nation by the University of Minnesota's College of Education and Human Development found that the cost per person for long-term care in Kansas has gone down over the last two decades, from $49,418 per person, per year on average in 1993 to $41,936 per person, per year in 2009.

In fact, several Department of Social and Rehabilitation Services studies have shown that we are underfunded by millions of dollars. Medical costs have gone down as well. According to numbers calculated by the Kansas Legislative Research Department, during the years from 2008 to 2011, pharmaceutical spending for persons with developmental disabilities has declined from $21.3 million to $18.5 million per year; hospital spending (inpatient and outpatient) decreased from $9.3 million to $7.2 million; physician and clinic expenditures have declined from $3.9 million to $3.0 million as well.

The spokesperson for the governor also indicated that there was a lack of care coordination for people with intellectual disabilities and that they did not receive recommended health care. I am offended by this comment, as are all of the employees at Tri-Valley Developmental Services, particularly our registered nurse.

In the article, she cites a 2010 University of Kansas study for this argument, but what she fails to do is tell the whole story; that the study only examined Medicaid patients from four small, rural CDDOs and the study did not include those persons with dual eligibility to Medicaid and Medicare.

Since Medicaid is the "payer of last resort," many of the dual eligible individuals (over 50 percent of our population) in the study may have had preventative screenings that were actually paid by Medicare, thus never showing up in the data reviewed by K.U. I did a quick review of how many of our clients received diabetes screenings and participated in medication management and that number was 100 percent.

The spokesperson also discussed the benefits of managed care. She argues that health care will improve. Health care will not improve with managed care. Studies have shown that managed care companies limit procedures and physician visits in order to maximize profits. This is true of all managed care companies.

Most of us have dealt with a big HMO or large insurance companies and we know how the system works. This administration also cites high incidents of cholesterol and diabetes in people with intellectual disabilities and the need to get that under control. However, a closer look reveals underlying causes that cannot be altered without jeopardizing the overall health status. The medication regimen for most individuals with intellectual disabilities includes one or more atypical antipsychotics. Atypical medications raise lipid profiles leading to high cholesterol and diabetes. Since this medication is the root of the health issue, little can be done to "change" the lipid profiles of this group.

Secondly, services will not improve with managed care, but will in fact become worse.

Managed care companies are in business to make a profit, the state has admitted this fact, and the only way they will be able to make a profit is to reduce services and funding. This includes reducing rates which will lead to employee layoffs. In Wisconsin, rates were reduced by 15 percent. The vast majority of our funding goes to staffing. Fewer employees mean less coverage, meaning more problems. In addition, managed care companies have little to no experience working with our population. The last thing I want is to be the guinea pig for a new managed care company.

Thirdly, they argue there will be improved efficiency. Adding another level of bureaucracy to an already bureaucratic process will only decrease efficiency. Not only that, but we will be dealing with three managed care companies, not just one. That means three different forms, three different contacts and the list goes on. Efficiency will not improve.

In addition, only five managed care companies submitted bids to provide managed care out of a possible 15 that showed interest originally. That has to be an embarrassment for the administration and only goes to show that the managed care companies are smarter than we think they are. They realized as well that KanCare, the state's new managed care system, is not very well planned, poorly coordinated and written by a select few who are not very well versed in the system.

What is particularly interesting about managed care in Kansas is that when Governor Brownback was a senator in D.C., he was one of the biggest opponents to Obamacare because he did not feel that government should force individuals to be part of the president's health care plan, but I guess it's allright for Brownback to force Kansans with intellectual disabilities to be part of the governor's health care plan.

Editor's Note: Tim Cunningham is the executive director of Tri-Valley Developmental Services, which serves developmentally disabled people in Allen, Bourbon, Neosho and Woodson counties.