Managed or mangled?

It makes little sense to Dr. Glenn Mead to take a system that worked for years and replace it with one tried before that failed.

And the Purcell dentist isn’t alone in scratching his head over Gov. Kevin Stitt’s decision to scrap the state’s existing SoonerCare and usher in SoonerSelect, a managed care organization, on October 1. Opposing that implementation is a broad coalition of health care professionals, Stop the Health Care Holdup.

The Oklahoma Legislature wasn’t consulted when the decision was made during the COVID-19 pandemic in 2020. Nor were the Oklahoma Hospital Association  and state associations representing doctors, dentists, nurses, osteopaths and chiropractors. 

Instead, the decision was pushed through the Oklahoma Health Care Authority whose members are appointed – and can be fired – by the governor alone.

Mead calls the MCOs “mangled care organizations.”

There are three options in health care, Mead said. Those are quality care, low cost care and quality care for everyone.

“He (Stitt) talked to his accountants and he knew more than anyone,” Mead said. “They are going for low cost.”

Mead is upset that the state’s overhead under the OHCA to run SoonerCare is 5 percent.

Under SoonerSelect, that overhead triples to 15 percent with those fees going to an out-of-state company with headquarters in Connecticut.

It’s ironic, Mead said, that more than 1,000 health insurance companies have headquarters in Connecticut, but that state doesn’t have even one MCO.

SoonerSelect health plans include medical plans through Blue Cross/Blue Shield of Oklahoma, Humana Health Horizons in Oklahoma, Oklahoma Complete Health and UnitedHealthcare.

Dental plans are DentaQuest, LIBERTY Dental and MCNA Dental.

The OHCA touts the benefits of managed care – improved health outcomes, value-based payment, improved member satisfaction, cost containment and increased cost predictability.

The coalition – and Mead – disagree.

“Simply put, managed care puts insurance companies in charge of patient care – something Oklahomans do not want,” a coalition statement reads. “The managed care plan will mean less access to care, a reduction in approved treatments and the loss of doctors and health care providers across the state.

“This ill-conceived plan would create delays for patients and allow insurance companies to ration medically necessary care for patients in Oklahoma.

“That’s unacceptable.”

The OHA noted in a news release that the OHCA’s “own actuarial advisor” has stated to achieve savings under the managed care plan, Oklahoma would need to reduce services to Medicaid patients by up to 40 percent.

“How do you think patients will react when the insurance companies tell them they cannot receive a necessary procedure or service?” the OHA asked.

Proponents of SoonerSelect argue MCOs provide budget stability and improved health outcomes. But the OHA counters “where is the demonstrable evidence?”

“The last time the state tried this, providers across the health care spectrum were unable to keep treating Medicaid patients under the new allowable service rate schedule,” the OHA stated.

“The result was particularly evident in rural Oklahoma because patients had to travel further – often much further – to receive services.”

The Legislature can opt to not fund SoonerSelect as it is proposed now.

House Bill 1091, the Ensuring Access to Medicaid Act, passed the House on March 11 on an 81-13 vote and is now before the Senate’s Appropriations/Health and Human Services Committee.

In part, the bill sets reimbursement and prior authorization time lines for providers treating Medicaid patients.

If passed by the Senate and signed by Stitt, the bill’s provisions would go into effect November 1.