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In the coming weeks, about 100,000 low-income families in Southeastern Wisconsin will receive packets of information in the mail asking them to choose from an array of new health care plans funded by the state’s BadgerCare Plus insurance program.  The state Department of Health Services has overhauled the program, signing new contracts with private health care providers which include new quality controls to address complaints the companies were under-performing.

The first third of the mailings, which will eventually be sent to all BadgerCare Plus members belonging to the Standard and Benchmark programs, are expected to go out next week. They’ll eventually reach all members of the programs living in Milwaukee, Waukesha, Washington, Ozaukee, Racine and Kenosha counties. Enrollees will choose from care plans drawn up by four health insurers: United Health Care, a national insurer based in Minnesota; Wellpoint, another national insurer; the Children’s Community Health Plan, connected to the Children’s Hospital of Wisconsin; and the Abri Health Plan, a West Allis company that specializes in managing BadgerCare Plus benefits.

Wisconsin’s Badger Care uses federal Medicaid funding plus supplementary state funding to extend more medical care to families than in many other states. Like most states, Wisconsin relies on a managed care system, whereby the state pays the insurer a set amount for each person enrolled in their plans rather than on a fee-for-service basis.

But Wisconsin’s Department of Health Services wasn’t satisfied with either the costs associated with its managed care system or the quality of care being provided. “We were not getting enough for our investment,” says Jason Helgerson, director of the Wisconsin’s Medicaid program. Some companies were “far under-performing,” he says, on quality control measures.

Those include the number of enrollees getting basic immunizations, lead testing for children and the prevalence of preventative care for diabetics and asthmatics – all efforts that both improve health while reducing the risk of other, more expensive health care services later in life. The department also measures how many of the company’s enrollees wind up at the Emergency Room for non-emergency medical issues instead of visiting a primary care doctor.

It selected the four companies for the program through a competitive bidding process this spring. DHS kept three, added one new one (Wellpoint) and cut another it had employed since 2001 – Managed Health Services, a subsidiary of Centene, a national provider of Medicaid services. Centene has had strained relations with area health care providers, according to a recent story in The Washington Post. The city’s two biggest health care providers, Wheaton Franciscan and Aurora Health Care, have refused to work with Centene over its low reimbursement rates for services.

Aurora President Nick Turkal told the newspaper the managed care companies in the state fall short of the goal given to them by state government: to get its Medicaid program enrollees involved in effective primary care. “The problem with this concept of managed care in Wisconsin is that it hasn’t really been managed,” he says.

Managed care providers in Southeastern Wisconsin have historically scored well below others in the state on quality control measures but serve patients with greater poverty and poorer health than in the rest of the state, the providers note. DHS counters that the companies serving Southeastern Wisconsin get the highest payments-per-enrollee in the state and should cope betters with the region’s ills.

Helgerson hopes the new, competitively bidded contracts will bring much-needed changes. New quality controls can result in payments to companies being docked as much as 3.25 percent, the strictest such penalties ever used in any state’s Medicaid programs, he says. In reworking their plans to bid for the state contracts, the insurers were required to expand their networks. “One of the concerns we heard was lack of access to specialists,” he says.

The new contracts, in total, will cost about $60 million less. Helgerson says the department is seeking to cut its spending of state and federal funds by a total of $600 million in 2010 and 2011. The new contracts will last until 2014, when major provisions of the federal health care reform package take effect and are likely to greatly increase the proportion of federal funding.

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