Starting to get down in the weeds – Spring Allergies, but rays of sunshine for Managed Care advocates?

Pat McGuigan, special to the Southwest Ledger

OKLAHOMA CITY – High winds and the Sooner State’s well-known springtime assault of windborne allergies are on the minds of many Oklahomans, including health care providers, analysts, legislators and medical professionals. 
Like spring itself, even as undeniable signs of hope emerge about the course of the worldwide 2019-2021 Pandemic of SARS-CoV-2 (COVID-19), daily work with irritated eyes and congested systems might drive some to distraction on anything other than immediate essentials of occupational labor.
But in and around the State Capitol, it’s hard to miss another sign of the times.

The Oklahoma Health Care Authority, with Oklahoma Governor Kevin Stitt’s concurrence, set the table for a major argument in late winter with the announcement that four providers would be tapped to administer the state Medicaid program, beginning this fall.
Winners (or losers, depending on an analyst’s perspective) of the first round in what will likely be a long fight were UnitedHealthcare, Blue Cross Blue Shield of Oklahoma, Humana Healthy Horizons and Oklahoma Complete Health
The quartet could assume management of Medicaid (including voter-approved expansion) on October 1.

The idea has determined critics. Emma Morris of the Oklahoma Policy Institute said, in a March 4 blog post, that “The Oklahoma Legislature is now the only entity that can protect the management of Oklahoma’s historically efficient, nationally recognized SoonerCare program from being hastily outsourced to private companies.”
The most notable counter to the HCFA/Stitt effort came from the powerful Oklahoma State Medical Association (OSMA). The association decried “outsourcing” of Medicaid and began maneuvering for what could be one of the most significant “Clash of the Titans” battle at the state Supreme Court in modern history.

Ray Carter of the Center for Independent Journalism, analyzed the early maneuvering of the OSMA and allies such as the Oklahoma Health Association (OHA) in a February 17 news story. He pointed out that “while the OSMA and OHA have both opposed managed care, neither group has identified any other way to control the spiraling costs of Medicaid, which has been consuming an ever-larger share of state tax dollars and may now see explosive growth due to expansion of Medicaid to include able-bodied adults.”
Carter further reported that while roughly three dozen state legislators have critiqued the selection of the quartet of providers, “none have offered an alternative means of cost control.” Stitt and the OHCA insist that oversight of patients in the Medicaid system would assure not only cost efficiencies but better patient outcomes.

As both Carter and this reporter have chronicled for years, other than public education, the state’s tax-financed health care systems are the major cost-drivers for government. From Carter’s reporting:
“From 1999 to 2019, total expenditures on Medicaid in Oklahoma — adjusted for inflation and including both state-and-federal dollars — surged from $2.33 billion to $5.6 billion.”

A new peer-review study touted summarized strong results in combating COVID deaths for a sample of nearly 39,000 Floridians in a Managed Care program.

The analysis from the American Journal of Managed Care found, according to a press release, that Cano Health’s “population health management program reduced COVID-19 mortality by 60 percent, compared to a mirror group of Florida patients.”
The “retrospective cohort study” included 38,193 MCPs (Managed Care Patients) in the Sunshine State who were monitored, the AJMC report said, “for COVID-19 incidence, hospitalization, and mortality.”
That cohort was “compared with a mirror group from the state of Florida.”

The abstract summary of reported results is striking: “The mean (SD) age among the MCPs was 67.9 (15.2) years, and 60 [percent] were female. Older age and hypertension were the most important factors in predicting COVID-19. Obesity, chronic kidney disease (CKD), and congestive heart failure (CHF) were linked to higher rates of hospitalizations. Patients prescribed off-label outpatient medications had 73 [percent] lower likelihood of hospitalization (P<.05). Compared with the mirror group, MCPs had 60 [percent]lower COVID-19 mortality (P<.05).”

Cano offered up its press release (with the study linked) on March 4.

The stage is set for an argument that seems never-ending. But the first stage resolution of the current debate will be resolved, one way or another, in time for Medicaid expansion (which passed with the narrowest margin of any constitutional referendum in state history).

Medicaid expansion was a close call in Oklahoma. It’s unlikely management of that expansion will be a slam dunk.

Note: This analysis first appeared in the Southwest Ledger, March 11, 2021 print edition and online:  Southwest Ledger, 7602 US Highway 277, Elgin, OK 73538, (580) 350-1111. It is reposted here with permission.