Sunday, November 19, 2023

Bill Crawford: Peace Looming Between MHA & Medicaid

Discord between the Mississippi Hospital Association (MHA) and the Division of Medicaid is dwindling.

Six years ago the discord was palatable. MHA and 65 of its hospitals formed a non-profit corporation, Mississippi True, that developed the state’s only provider sponsored health plan. Mississippi True then competed for one of the state’s lucrative Medicaid managed care contracts. Under the leadership of Gov. Phil Bryant’s appointed director David Dzielak, Medicaid ranked the hospitals’ proposal next to last.

Lack of experience appeared to be a key issue. Mississippi True “argues it will never have the experience necessary to win an award if it can't get the contract because of a lack of experience,” reported the Clarion-Ledger. “They structure the RFP to give the contract to whoever they want,” complained Sen. Angela Hill.

The hospitals and MHA protested and took Medicaid to court but to no avail. United Healthcare, Magnolia Health, and Molina Healthcare got the precious contracts.

After a while, the discord began to ease. Notably, when new proposals came up for review last year, Medicaid, under the leadership of Gov. Tate Reeves’ chosen director Drew Snyder, ranked the hospitals’ TrueCare proposal first.

“The top two ranked Offerors are TrueCare and Magnolia, each of which delivered especially strong Technical Qualifications, including innovative and ambitious approaches to delivery of services,” said Medicaid’s notice of intent to award. Molina was third-ranked and got the final award. United Healthcare, ranked fourth, lost out.

Three significant changes affected the hospitals’ proposal. First, the hospitals learned a lot from their earlier application and worked diligently to develop an exemplary proposal. Second, Snyder replaced Dzielak as Medicaid director. And third, hospitals changed their administrative services partner to CareSource. The change to CareSource was significant. CareSource’s considerable experience clearly aided the rankings. And both TrueCare and CareSource are nonprofit organizations which allows them to emphasize service while the for-profit companies tend to emphasize profit.

The hoped for result is that all healthcare providers will see locally controlled TrueCare as a trustworthy partner dedicated to improving patient health outcomes. In particular, hospitals expect TrueCare will pay providers’ Medicaid claims more expeditiously and with fewer disputes. Any net differences between service costs and Medicaid’s capitated payments will not go to hospitals but into TrueCare capital reserves.

Final award of the new Medicaid contracts has been pushed back for at least a year. United Healthcare and Amerigroup protested to the Public Procurement Review Board. The board is expected to set a hearing date on the protests at its December meeting. Note: the protest left the current providers, including United, in place for an extra year.

If the protests get resolved as expected, come next July discord between MHA and Medicaid will have transformed into accord.

“For everything there is a season…a time for war, and a time for peace” – Ecclesiastes 3:1,8.

Crawford is a syndicated columnist from Jackson.

Posted by Kingfish at 8:25 AM

6 comments:

Anonymous said...

This has nothing to do with different medical factions. It has to do with how much more money the highest paid sectors in this improvise state can can suck out of this impoverished state.

November 19, 2023 at 7:02 PM
Anonymous said...

Moreover, it has to do with who best knows Tater.

November 20, 2023 at 3:26 AM
Anonymous said...

@7:02 PM
Did you flunk out of med school or did you even make it through pre-med?

Every day I have to deal with the most unhealthy, irresponsible, unhygienic, and ignorant patients, I could ever imagine. I can’t imagine what goes through the mind of someone who won’t even bother to bathe before a medical visit. I deserve to be paid much more than I currently earn. Money is the only thing that suppresses the loathing for the human debris.

November 20, 2023 at 6:19 AM
Anonymous said...

Hogs being called to the trough.

November 20, 2023 at 6:46 AM
Anonymous said...

"And both TrueCare and CareSource are nonprofit organizations which allows them to emphasize service while the for-profit companies tend to emphasize profit."

Anyone who actually thinks that the "money side" of healthcare, even the entities involved that are "nonprofits," is not concerned first and foremost about profit and the money its people are making is delusional. The "money side" will become concerned about annoyances like patients and their care/outcomes right after Walmart, Target, Home Depot, the automakers, and every other private/public for-profit company announce that they are no longer concerned about profits as long as their customers can buy the products they want at prices they can truly afford. In simple terms, the "money side" of healthcare is concerned with the money, not health or care.

And it is at all levels nowadays. An exhaustive search would turn up a handful of doctors who truly put patients ahead of their own finances, but for the most part, show me one doctor who went broke providing care to those who could not afford current healthcare prices and I'll show you two unicorns. Show me medical support staff who truly demonstrate they are working for the patients and not the money, and I'll show you a doctor who went broke. Show me an administrator who puts patients ahead of personal income and I'll show you a doctor who went broke AND two unicorns, one ridden by the Tooth Fairy and the other by Santa Claus. To be fair, show me a ditchdigger who is more concerned with the happiness of the dirt he digs than his own income and I'll show you a hospital admin who carpools with Santa in a sleigh pulled by two unicorns.

November 20, 2023 at 7:08 AM
I Have You Pegged said...

To the Doc at 6:19 - Methinks you are ill-suited for the profession from which you currently suck oxygen. I would recommend a professorial role at either Millsaps or Yale.

Your disdain for the proletariat has got to precede you into the exam room.

One of my several doctors comes into the exam room, 70 minutes after my appointed time, never makes eye contact, no handshake nor fist-bump, takes a seat at the computer, grunts three or four questions, wipes snot from his nose, says my numbers look OK and leaves the room. I think he's coming back, but I'm wrong. The nurse comes in and tells me to follow her to the checkout window where another woman tells me I'm good to go.

I think that's YOUR clinic.

November 20, 2023 at 8:41 AM

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Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.

In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

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This is definitely a Beaver production.

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Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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