Since KanCare was launched in 2013, many stakeholders have questioned how effective the program is, given that significant challenges persist. To better understand whether these challenges are impacting the program’s ability to meet its original rationale and commitments, the Kansas Hospital Association, the Kansas Medical Society and the Kansas Association of Medically Underserved have engaged with Leavitt Partners to complete a review of KanCare.
The results of this review were presented on Nov. 17 to the Bob Bethell Joint Committee on KanCare Oversight. As detailed in the full report and report brief, an overwhelming number of respondents do not feel KanCare has met its goals and commitments. Providers do not believe there have been improvements in quality of care for KanCare recipients. The report also indicates that the current system is not meeting the stated commitments to improvements in care delivery and promoting health and wellness.
The assessment process included interviews and surveys with hospitals, health clinics and physicians, as well as a review of federal and state documents related to the KanCare program. This data review included quarterly and annual reports to Centers for Medicare and Medicaid Services, Kansas Department of Health and Environment data reports, KanCare annual external quality review technical reports, and metrics and provisions outlined in the waiver’s terms and conditions.
“We see this as an important collaboration among major health care organizations interested in the success of the KanCare program,” says Tom Bell, president and CEO of the Kansas Hospital Association. “The report comes at a crucial time as we prepare for the 2017 legislative session and the state’s request for the KanCare waiver to be renewed.”
The report recommends the following changes be made to the KanCare program:
1. Increase administrative simplification and standardization across the managed care organizations (MCOs), including standardized appeals, prior authorization and credentialing processes.
2. Amend current MCO contracts to include a minimum medical loss ratio of at least 85%.
3. Increase oversight of the MCOs and transparency.
4. Improve communication with the MCOs and with KDHE.
The KanCare program operates under a CMS-approved 1115 wavier, which must be renewed by January 2018.
Leavitt Partners is a health care intelligence firm founded by Michael Leavitt, former U.S. Department of Health and Human Services secretary and former governor of Utah.
The Kansas Hospital Association is a voluntary, nonprofit organization existing to be the leading advocate and resource for members. KHA membership includes 211 member facilities, of which 126 are full-service, community hospitals. Founded in 1910, KHA’s vision is: “Optimal Health for Kansans.”
Source: Kansas Hospital Association