There won't be a parade or big-name band appearances. But maybe there ought to be.

The Kansas Department of Social and Rehabilitation Services' managed care program for the Kansas Medicaid population begins in earnest when Wyandotte County goes on line Friday, December 1. Preparation for this start-up has been in the works for more than two and one-half years and involved members of the Kansas medical community (including physicians, pharmacists and hospital administrators), state medical program staff, and consumers and consumer advocates.

In the next few months, Medicaid consumers in other well-populated eastern Kansas counties including Leavenworth, Johnson, Douglas and Shawnee, will join Wyandotte County consumers in the new managed care programs. All other counties will soon follow. By July, 1997, 80 percent of the state's 200,000 Medicaid consumers will be part of the state's managed care program.

SRS has successfully reached out for help both to the medical community and to Medicaid consumers in planning the new programs. The medical community's knowledge about how programs should work and the consumer's knowledge of their needs are key to the success of this major change, said SRS Secretary Rochelle Chronister.

Inclusion is key," Chronister said. It takes tremendous cooperation to move from a large, fee-for-service system to managed care providing health care services using one physician or organization as a gatekeeper," she said. Getting consumers and medical providers involved is key to the success of managed care."

With managed care, SRS, as directed by the Kansas Legislature, is completely revamping the method by which medical services are provided to vulnerable Kansans. The goals of managed care are three-fold -- increase access to medical care for the population served by Medicaid, improve the quality of medical services, and prevent unnecessary costs.

Managed care provides health care services using a single doctor or organization to emphasize preventive health care and a reduction in unnecessary care and cost. Medicaid consumers choose the doctor or organization they want to be their primary care provider. The primary care provider will supply all preventive and primary medical services and refer patients to specialists when needed.

One of the two new managed care programs, HealthConnect, is operating well in Saline, Ottawa, Ellis and Ness counties. Under HealthConnect, Medicaid consumers designate a primary care provider to provide for their health care needs. The primary care provider is reimbursed on a fee-for-service basis in addition to a monthly case management fee. This type of managed care eventually will be available statewide, even in rural areas with no other managed care plans.

However, in Wyandotte County, HealthConnect and PrimeCare Kansas, a managed care program using health maintenance organizations under contract with the state, will be brought on line together for the first time. Three HMOs, Humana, HealthNet, and Blue-Advantage+ Plus, will provide health care services to Medicaid consumers in Wyandotte County who choose an HMOs as their provider. PrimeCare Kansas is capitated managed care, with the HMOs paid a fixed rate for the population served.

Enrollment for the managed care programs in Wyandotte County took place during October. Of the 16,000 beneficiaries, about 3,000 chose to join an HMO. Hundreds of beneficiaries attended one of 25 informational meeting about managed care before making their choice.

In more populated Kansas counties, most Medicaid beneficiaries, including those receiving benefits from the Aid to Families with Dependent Children (AFDC) and the Poverty Level Women and Children (PLE) programs, will have a choice between enrolling in the HealthConnect or a capitated managed care plan. Medicaid beneficiaries in the Supplemental Security Income (SSI) program and the General Assistance (GA) program will be in the HealthConnect program.

Ann Koci, commissioner of Adult and Medical Services for SRS, said the new managed care programs will be a major improvement for beneficiaries and health care providers alike.

It's a consumer-driven system, where responsibility is placed in the hands of the consumer to choose their gatekeeper to the health care system," she said. Suddenly, the consumer is in the driver's seat. Beneficiaries will no longer have to battle to get their health care."

Data from Wyandotte County shows the number of choices Medicaid beneficiaries will have concerning medical care already has increased significantly. Beneficiaries will have a choice among 113 providers, as well as 104 providers within the three HMOs, who have made 131,691 openings in their medical practices available. Primary care providers include physicians, advanced registered nurse practitioners, clinics, or, in the PrimeCare Kansas program, a primary care provider within a Health Maintenance Organization.

As the new managed care programs come on-line, there is bound to be an adjustment period, especially for consumers or providers who have not attended any informational meetings. Consumers enrolled in a PrimeCare Kansas HMO should call the HMO for assistance. Consumers enrolled in HealthConnect can call 1-800-766-9012 for assistance.

Page Last Updated: May 29, 2001