Time on Managed Care

Maine legislators were informed last week the Department of Health and Human Services would have trouble awarding a managed-care contract for mental health services by Jan. 1, 2007. This is of particular interest to legislators for several reasons, one of which is that they have already booked savings of more than $10 million from the contract for next year. But rather than scold the department for being late, they should praise it for being cautious.

What may cost Maine short-term – it’s not clear how much, if any, of the $10 million will be lost – will save it many times over long term if the state responds to a level of readiness rather than deadlines. Of course, it should try diligently to meet legislative deadlines, but when it’s clear that won’t happen, faking it leads to the sort of mess produced by the Medicaid computer meltdown last year.

Mental-health advocacy agency NAMI-Maine has been urging the state to slow down on its path to managed care so the department could gather more information from those potentially affected by the changes. That is a fine reason, but the department likely could not have proceeded anyway because it had not received cost data to generate a request for proposals. That data was due in April; it is now expected by early October. The department attributes the delay to “the complexity of codes and funding mechanisms supporting the behavioral health system.”

Why the department didn’t know ahead of time about these challenges may be something legislators should examine. But, with a requirement that Maine receive federal approval to put a managed-care system into place, legal requirements to keep affected families involved, savings targets to hit and additional federal reviews for quality, access and cost, “complexity” doesn’t begin to describe what’s ahead for the department.

From the beginning of the managed-care reform, state officials have said that access to care is more important than expected savings. Legislators should understand this too, both as the change takes place and when a specific contract is proposed. For instance, any contract must come with a high degree of transparency so that the public can easily determine if the new system is performing as advertised.

Done properly, managed care can reduce costs and extend care to more people. Doing it properly will take time, and legislators do well when they give the department enough time to succeed.