Study: Poor kids rarely see MDs and Dentists
DSS Mystery Shoppers 'uncover' Lack of Access to Care
By Mary E. O’Leary, Register Topics Editor
November 29, 2006
A firm hired to test access to the state’s $700
million health care program for poor children, on
average, was unable to make appointments for new
patients in three out of four cases, with the lack
of providers willing to take Medicaid patients the
main reason.
The dismal results were no surprise to advocates who
have listened to complaints of patients for years
that lists of physicians provided by the managed
care organizations are inaccurate when it comes to
the Medicaid population.
Despite "substantial anecdotal evidence" that the
lists of providers are often misleading, "the MCOs
have denied the existence of any serious access
problems," said Sheldon Toubman, an attorney with
New Haven Legal Assistance Association.
Dr. Robert Zavoski, president of the Connecticut
chapter of the American Academy of Pediatrics, was
blunter.
"The state is paying a lot of money for a system
that is broken. Fewer and fewer people are able to
get care ... the Medicaid managed care system needs
to be scrapped," Zavoski said.
Mary Alice Lee of Connecticut Voices for Children,
said the findings "were very disturbing, but not
entirely inconsistent with what we have been
reporting for a number of years."
Using a model called "mystery shopper," the state
Department of Social Services this summer hired
Mercer, a consulting service out of Phoenix, to
attempt to schedule pediatric physicals, dental
checkups and appointments with a dermatologist, a
neurologist and an orthopedic surgeon.
(See WNPR Coverage Below)
It further said the provider listings contained
inaccurate and out-of-date information and followup
calls to the MCOs confirmed the inaccuracy of the
provider listings.
On customer service, the shoppers said almost
one-quarter of the staff members of providers were
not courteous and "many" of the staff members for
physicians attempted to deter the callers from
making appointments.
The sample consisted of 1,851 randomly selected
providers listed by the four health organizations,
which were hired by DSS to run the $700 million
Medicaid program.
The program serves some 316,000 individuals, 220,000
of them children through age 18 in the state’s HUSKY
(Healthcare for Uninsured Kids and Youths)
program.
The four MCOs are: Community Health Care Network,
Anthem Blue Cross — Blue Shield, Health Net and Well
Care. The Mercer report involved only new
patients.
Lynn Childs, vice president for health services for
Community Health Care Network, said the findings
were a surprise, as their internal monitoring showed
higher access.
"The results are not what we want from our
networks," said Childs, who said CHCN now plans to
query physicians on a quarterly basis to update
provider lists.
The "shoppers" were only able to schedule 34 percent
of appointments for physicals; 27
percent for dental checkups; 30 percent for
dermatologists; 16 percent for a neurologist and 17
percent for orthopedic surgeons, for an average of
26 percent.
Matthew Barnett, spokesman for DSS, said they have
asked the MCOs to update their lists of providers,
which could take several weeks, while he said the
groups are required to immediately train staff to
provide additional help in scheduling
appointments.
Barnett said the "mystery shoppers" called on behalf
of new patients who did not yet have primary care
providers and therefore might be delayed in getting
appointments, while DSS also anticipated higher than
usual problems with the specialists about whom they
had already received complaints.
But Mercer, in its study, corrected for what it
called reasonable delays, such as lack of a
particular sub-specialty in a practice, and the
interim period before a primary care physician is
assigned.
The subsequent number of shoppers who were unable to
make an appointment was still high, ranging from 55
percent to 70 percent of patients.
Scott Markovih, regional vice president for Anthem
Blue Cross and Blue Shield in Connecticut, said
other problems identified over the years have been
dealt with and he viewed the findings "as yet
another opportunity to critically assess and enhance
the experience" of patients.
Alice Ferreira, spokesperson for Health Net, said
they are working on a "multi-prong" approach to
address the issues, but immediately they are setting
up a dedicated customer service line for Medicaid
patients.
Lee said federal regulations mandate that patients
be offered assistance in getting appointments.
"Clearly families need more help then they are
getting," she said.
İNew Haven Register 2006
WNPR Coverage
WNPR reported that Michael Starkowski, Deputy
Commissioner, Connecticut Department of Social
Services said that DSS "has already put into place
some activities with the managed care companies that
will correct the deficiencies identified in the
report." They reported that he said the Managed Care
Organizations will be required to submit updated
lists of
doctors on a quarterly basis.
Click
here to listen to the story.
Editor's Note: In our view the lists may be out of
date, but the underlying problem is that
reimbursement rates for dental care have not been
increased since 1992. Updating the lists will only
show that the number of providers actually available
is much smaller.
Send us your news and stories on access to oral
health care issues for future
Updates.
Send them, in electronic to the
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About Connecticut Oral Health Initiative
The Connecticut Oral Health Initiative, or COHI for
short, is a state-wide collaborative of dental
professionals, business and community leaders. Our
Mission is Oral Health Care for All. We work to
persuade, educate and inform decision makers and the
general public about the important issues involving
oral health. We started in 1992 as a project of the
Connecticut State Dental Association and
incorporated as a separate 501(c)(3) non-profit
corporation in 2003. We are supported by your
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Connecticut Oral Health Initiative
Marty Milkovic
Executive Director
phone:
860-246-COHI (2644)
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