One vehicle used by states to control escalating health care expenses is assigning Health Maintenance Organizations (HMOs) to manage costs. Michigan Medicaid is overseen by a 30 member advisory council. Comprised many of health care association and agency leaders, the board approved the use of HMO agreements to assist in administering services.
Medicaid recipients are free to choose the HMO of their choice just as company employees select their HMO from the array offered by the company. This may sound perfectly harmless, however if the future public option is organized the same way as Medicaid, companies will face some difficulties.
No longer would a retail company or health care organization be able to insist on or give a discount to employees using their own pharmacies. In fact, their employees could be forced to shop elsewhere. Rx America was chosen by several Medicaid HMOs to fill expensive or mail order scripts. Earlier this year CVS Caremark purchased Rx America. Medicaid recipients have no choice but to use CVS when filling the scripts as dictated by the HMO, even if they work for a CVS competitor. This may seem a mute point but do not overlook its significance. kroger pàystub
Autistic individuals are generally Medicaid recipients. Kroger and Meijer have done outstanding work at offering work to this population and both operate competitive pharmacies. The Autistic population is a very loyal to their employers but unable to have some scripts filled by their employer.
Keeping your doctor
Like non-Medicaid HMOs, Medicaid HMOs have participating physicians that are covered. Non-participating physicians will not see a patient. Recipients may switch HMOs annually however they will not be able to keep their doctor unless the doctor participates in the new HMO.
Another situation caused by the HMOs is in the basic principle that not all HMOs are patient-centered. Some are too focused on the bottom-line to offer customer service, especially when the customer cannot easily change HMOs.
In at least one incident, one HMO denied a doctor’s script for an expensive drug despite a history of effectiveness prior to the Medicaid recipient’s selection of the HMO. Despite documentation from the doctor, the HMO was steadfast. The client elected to invoke a patient’s right to go to the Michigan Healthcare Tribunal for mediation. The Tribunal notified the HMO of the pending action and the HMO dropped the recipient.
If actions such as this are not effectively handled by a new public option, employers can expect to be caught up in the circumstances. HMOs operate during normal business hours, meaning employees would be forced to contact their HMO on company time as break periods are often shorter than the hold time to call an HMO. Unlike the case when the employer has a relationship with their health care administrator, in the public option no such relationship would exist, leaving the employers unable to assist the employee beyond attempting to somehow reduce the increased stress level. These are just two of the problems to be faced by employers as they seek to maintain a healthy work environment for their employees.