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April 8, 2004

Manage This

Maybe it is just my background in college Journalism talking, but it seems there be something mighty fishy about managed healthcare organizations in New York State. Take this chart I put together today, as part of an effort to explain why the hospital where I work is experiencing a decrease in Medicaid revenue; It shows Medicaid Managed Care enrollment in Brooklyn, according to the New York State Department of Health, since January last year. If you do the math, enrollment appears to be up about 20% over last year. And the numbers appear to be climbing still. This means people who are eligible for the public New York Medicaid program in Brooklyn are choosing to "switch" their insurance to a Managed Medicaid private insurance plan, in what appear to be record numbers. I happened to be walking down Church Avenue here in Brooklyn over my lunch hour today, and by complete coincidence got a firsthand understanding of why so many people are signing up with these Managed Care Organizations (MCO's); In the course of my 15 minute walk, I ran accross at least 3 of these tables, all with a Managed Care representative standing nearby, aggressively hawking "free health insurance!" I asked one of the reps how the insurance could be free, he explained, "The state pays for it." In other words, New York State pays a flat rate per enrollee to the Managed Care Organization, and the MCO then "manages" that person's healthcare. Typically this involves limiting the enrollee to "in plan" physicians, requiring special pre-authorization for healthcare procedures, and in the case of Home Health care, severely limiting the allowed number of home visits (if the enrollee can even get authorization for any visits in the first place). There were also a number of bus stop ads for different Managed Care companies, similar to this one offering the highly tantalizing "free car service!" if you sign up with HealthFirst; And a sample of the many brochures I had stuffed into my hand as I walked past the tables; On the way back from my walk down Church I started putting a few things together. Something just seemed ugly about this whole arrangement. Church avenue near where I work is hardly an "affluent" neighborhood. And here are all these Managed Care companies (there were at least 4 represented in as many blocks) pushing their "free" insurance to everyone on the street. It could be argued, I thought, that these companies are deliberately setting up shop in areas where people lack the resources and time to do any research to see if they are getting a good deal. And it is my contention that they are not getting a good deal. I know they are not, I work for a hospital, and I know a Managed Care eligible patient does not get the same services as a straight New York Medicaid eligible patient. Not only that, but the hospital department where I work is projecting a Medicaid revenue loss of about 20% vs. last year, matching quite closely the graph of Managed Care enrollees above. Do you know what a revenue loss of 20% means to a non-profit hospital in New York City? Well for one thing it means the hospital could close, and I could lose my job- which is no doubt the reason I am all up-in-arms about this subject in the first place. Some will argue it is a good thing Medicaid expenditures are being limited; weaker, less well-run hospitals, too inefficient to handle the revenue "fluctuations", will close and give way to better-run organizations that will ultimately give better care. However this argument has no legs to stand on; all the hospitals in poor areas of Brooklyn (where the MCO's appear to be plying their trade the hardest) are utter horseshit (not including the hospital where I work, I am of course obligated to mention). How do I know? I have been to all of them! You don't have any clue how close to "shithole" these places can be, unless you have actually been there. If one closes, it just means people living nearby will have to trudge even farther from home to get the same horseshit care at the next one over. Universal healthcare, anyone?

1 Comment

Great "article". Clear, to-the-point and well illustrated. I'd give it an A as an outline for a full-scale expose. So - what can one do about supporting universal health care? Sharon Osborne plugged it on her show not long ago,(YES I like Sharon occasionally) and the whole audience, mostly younger folk, cheered. Maybe someone should call Sharon???