For starters, the state needs to start paying closer attention. Patients must have advocates and a transparent and fair appeals process. And penalties have to be assessed and paid when companies don’t measure up.
The system also pays companies up front. We’d prefer withholding some payment until performance can be evaluated.
Texas is by no means alone with problems with its managed-care system, says Andy Schnieder, a professor and researcher at Georgetown University’s health policy institute for children and families. But it might find solutions and guidance from some states that are doing things right.
Some tools already exist. Texas just has to use them.
For example, Medicaid rules allow states to initiate independent reviews of company plans for quality and care and to validate whether data is accurate. States can identify specific performance improvement projects for plan participants and hold them accountable for carrying them out. These ideas have proven successful elsewhere.
Iowa’s ombudsman oversaw and held plan participants accountable for addressing concerns over care for its residents with disabilities. And a May federal government report shows how New York has used regular audits to monitor its program.