Basketball was invented in Kansas, so it’s only fitting that Blue Cross and Blue Shield of Kansas chose to take their ball and go home when that state’s governor offered them a winning shot at changing how Medicaid coverage is provided to the disabled and elderly.
KanCare, described in an executive summary issued by Kansas Governor Sam Brownback as a “care coordination program,” asks the federal government to waive some of its own rules so that poor families, individuals with disabilities, and the elderly can be brought under its coverage. What makes KanCare’s brand of reform unique—and probably terrifying to Blue Cross and Blue Shield—is that it is built to deliver care according to these themes: provide integrated, whole-person care; preserve or create a path to independence; and provide alternative access models, and emphasize home- and community-based services.
I can certainly see why an insurance provider would run screaming from such destructive ideas.
If an industry giant like Blue Cross is uncomfortable with a management approach that promotes patient independence and a 360-degree view of personal care, other KanCare provisions will seem downright blasphemous, such as the program’s proposal for a version of Medicaid to Work program that would operate hand-in-glove with the Department of Commerce to pair potential employers with disabled Kansans who are out seeking jobs. And there is something else in the executive summary that may make big insurance swoon: KanCare’s plan to shift to a person-centered care coordination model and realign state agencies projects an $853 million savings over the next 5 years.
So how did Blue Cross and Blue Shield react to Brownback’s KanCare plan, scheduled to begin January 1, 2013? The organization responded by not bidding on a contract to help manage the program. The company reported to the Associated Press (AP) that it balked at offering a bid because the care coordination program would have required the insurance giant to do things it has not traditionally done. Blue Cross spokesperson Mary Beth Chambers explained that aspects of the plan that would have required the insurer to help families decide whether elderly members should go into a nursing home—and to manage that care—were simply not within the company’s purview, and therefore helped to form the company’s decision not to participate in the bidding process.
Is helping families make decisions about care and care management for elderly loved ones really outside the scope of operations for a health insurer? Really? Chambers added to her remarks: “We just felt it wasn’t responsible for us to commit to changing our business model that much.”
By all means, let’s not expect health care insurers to roll up their sleeves and work for the improvement of health care.
Not all view the Blue Cross decision through such a cynical lens; in fact, there are some in the Kansas Capitol who express sympathy for the insurer. Some critics of the managed care program reportedly have suggested Brownback’s January 2013 start date is too rushed. Others such as Republican state senator Dick Kelsey told the AP that Blue Cross may have actually wanted to offer a bid but concluded it could not be completed by the February 22, 2012 deadline. I’m guessing, however, what really caused Blue Cross to walk away had more to do with Democratic state representative Jim Ward’s report that the administration promises to not shut participants out of Medicaid, reduce their benefits, or reduce payments for health care providers.
KanCare draws from the best components of similar models used in Michigan, Pennsylvania, Tennessee, and Texas. What this plan demonstrates is that states needn’t wait for the federal government’s Affordable Care Act to take the lead in pioneering innovative and beneficial care for the citizenry. Perhaps Blue Cross turning up its nose from KanCare is actually a good sign that innovative health care reform is incompatible with old establishment insurers, and the program will open the door for a hungrier, more inventive firm to help blaze this trail. Some things Kansan may not hold universal appeal—tornados and an endless flat horizon are just two. For the long-term rehab community, however, the idea of a coordinated care program that is outcome oriented and does not consider provider rate cuts the go-to method for holding down Medicaid costs, is worth supporting. Learn more about KanCare at governor.ks.gov, then talk among your profession and friends and see if good sense can’t be contagious.
Editor’s Note: Access your free digital edition of this issue from our home page, complete with new and engaging interactive content.