During recent weeks, The Des Moines Register has published articles and public comment related to a managed care practice I call “half-managed care”. “Half-managed care” happens when a managed care organization interrupts care.

In our experience in Louisiana, half-managed care occurs whenever a managed care organization (MCO) refuses to continue authorizing intensive residential care before a child’s treatment is complete. This decision by an MCO is based on the hope a child’s next “step down” level of care will be sufficient to meet the child’s needs in a community.

Especially for children in foster care who have the most extreme needs (and who may bounce among placements like the multicolored balls in a child’s push-along “corn popper” toy), the care these children require when they return to their communities is not available or the intensity is insufficient for their needs. This results in particularly high readmission rates. These readmissions occur because the first denial of authorization for care was premature or the services a child needed were not available to her or him following discharge. (I call too many readmissions, the “churn rate”.)

If a child whose care was discontinued had remained in intensive residential care long enough to complete all treatment, the results would likely have been more positive. We know this from our experiences caring for these children prior to managed care’s move into child welfare.

I find these news stories in The Des Moines Register interesting because they offer a balanced flavor of the dynamics experienced there, in Louisiana, and probably in all states where managed care is conflicted by a profit motive. (As I understand it, there are two general ways MCOs are paid — in the Capitation model, the MCO receives a block of money and what is not spent on treatment is retained by the MCO; in the Fee For Service model, the MCO acts as a transaction processor/authorizer. The Fee For Service model removes an MCO’s profit motive from decisions regarding treatment. Under the former Louisiana Behavioral Health Partnership, Louisiana used the Fee For Service model. Now, under Healthy Louisiana, our state uses Capitation.)

I believe these articles from Iowa provide insight and perspective from both sides of the discussion – those of a child’s parents and those of an MCO’s regional vice president and senior medical director. As you will read, the well-being of a child is suspended over the gap between the two positions.

Reader skeptical of Amerigroup’s desire to help children with mental health issues

Helping children with ‘heartbreaking’ mental health issues

Editorial: Private Medicaid’s latest victim is Iowa teen

Rick Wheat, President/CEO
Louisiana United Methodist Children and Family Services

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