For many years, many Kansans who are poor or disabled have been segregated in terms of health care.

They have had the right to receive health care services through the Medicaid health insurance program, which serves persons who qualify because of low incomes or disabilities. But often, they had trouble finding a doctor to see them. And the kind of health care they received became episodic in nature and too often came in the emergency room when health conditions deteriorated.

Managed care is changing that. A Kansas City nurse said Medicaid Managed Care has created the first `medical home' for many beneficiaries, most of whom are women and children. A Fort Scott doctor had another description: "You know who your doctor is and your doctor knows you."

Two years ago, the Kansas Legislature told the Department of Social and Rehabilitation Services (SRS) to change the system for providing medical services for people in the Medicaid program. That mandate -- a massive change in health systems -- has now been fulfilled.

Almost 100,000 Kansans in most of the state's 105 counties who qualify for the Medicaid program because of poverty or disabilities are now enrolled in Medicaid Managed Care.

What does the change mean?

As Medicaid Managed Care was first being set up, a Topeka doctor described what had

been happening under the previous system. Dr. Raymond Magee, who served on the initial Statewide Implementation Committee for managed care, said the Medicaid population had been "set off by itself, on its own, for a long period of time.

"We need to make an effort to educate them and get them with other populations," Magee said. "Include, not exclude them. We need this population integrated with the rest of society."

Integration comes by inclusion, and Medicaid Managed Care is about inclusion.

The program now includes many doctors and other health care professionals who previously did not see Medicaid patients. Much of the increase in the number of health care providers in managed care came because private managed care systems, Health Maintenance Organizations (HMOs), have joined with SRS in serving the Medicaid population.

With managed care, Medicaid consumers choose a primary care case manager for their health care needs. The primary care provider, which could be a doctor or advanced registered nurse practitioner, supplies all primary and preventive medical care and refers patients to specialists when needed.

While much of the information that will show exactly what kind of health care improvements managed care has made for Medicaid beneficiaries is not yet available, signs already point toward success. A study done by SRS showed that in Kansas counties where managed care was in operation, more than 20 percent less was being spent on emergency room use compared with counties where managed care had not yet started.

Another study done by the Kansas Foundation for Medical Care under contract with SRS showed the vast majority of people in managed care know the primary care provider they need to contact for medical care. The study also showed they like the health care they are being given and do not want to change health insurance plans.

"With managed care, we wanted to see Medicaid consumers develop a steady, regular relationship with their health care provider," said Ann Koci, Commissioner of Adult and Medical Services, the SRS division that has been working with the medical community to bring managed care on line. "A decrease in the use of emergency room shows individuals have someone to go to for their health care. They are connected to the health care system."

Dr. Wayne Wallace, an Atchison physician, said one idea behind managed care is to get patients and their health care provider better connected. As one of the managers of the emergency room at the Atchison Hospital, he sees firsthand the value of this connection.

"With managed care, we try to get the patients to understand they need to be in contact with their primary care case manager," he said. "Ideally, working with their case manager, they can find an alternative that can be done before they go to the ER."

Dr. Wallace is chairman of the Peer Education and Resource Council (PERC), a group of 11 physicians, pharmacists, osteopaths and nurses from across Kansas helping the state make the move to managed care. Their charge is to help provide education and quality control for the providers and consumers of medical care in HealthConnect, one of two managed care programs for the Medicaid population. The other managed care program is PrimeCare Kansas, with private HMOs contracting with the state to provide care for Medicaid patients.

Wallace said they have been working well with state health care administrators to adjust the managed care program to meet the needs of both providers of health care and patients.

"Our goal is that the care of the Medicaid population is just as sophisticated and has the highest standards as any other group, in spite of the fact they may have economic problems," he said.

Fort Scott doctor Marty Schmidt said in the past, Medicaid recipients were often treated by the medical community as "second class citizens." Also a member of the PERC committee, Dr. Schmidt said managed care is "an attempt to treat everybody the same." He said continuity of care -- the forging of that provider/patient relationship -- is key to the success managed care will have.

"When you are seeing a different doctor each time and going to the emergency room, nobody knows what's going on with your health," Dr. Schmidt said. "You may miss something horrendous."

Sallie Page-Goertz, an advanced registered nurse practitioner who works at the Kansas University Medical Center's Child Center, was one of many people involved with the start-up of Medicaid managed care who praised the way the state has gone about setting up the program. Also a member of the PERC committee, she was involved in the start-up of managed care in Wyandotte County, the first large county to come into the program.

"SRS is really trying to achieve a balance between consumers and providers of medical care -- trying to bring quality service to consumers and still stand up for providers," she said. "It's been a team effort that will benefit the Medicaid consumer in the long run."

The team effort also shows with the private HMOs in the PrimeCare Kansas program. Dave Mullikin, vice president and chief executive officer of Blue Advantage + Plus in Kansas City, Mo., said even before the program started, SRS asked for input from them and others. Blue Advantage + Plus, Horizon Health Plan, and HealthNet are the three HMOs currently under contract with the state in the PrimeCare Kansas program.

"Even before implementation -- before the program even started -- the state listened," Mullikin said. "They listened to HMOs, physicians, consumers...everyone. They took the best practices from all different entities."

Page Last Updated: May 29, 2001