In a desperate search for any good news about her Medicaid privatization debacle, Governor Kim Reynolds is depending on a flawed Medicaid survey done by J. D. Power. Best known as a car rating company, Reynolds is holding up the J. D. Power survey to justify the mismanagement of her health care crisis. She claimed in an August press release that Iowa Medicaid patients’ satisfaction level ranks second highest in the nation based on the J. D. Power survey.
It’s very clear J.D. Power’s online survey of a few Iowa Medicaid enrollees wouldn’t pass any credible test of reliability. The J.D. Power company didn’t even bother to come to Iowa to kick the tires or raise the Medicaid hood. Governor Reynolds is trying to sell Iowans a Medicaid lemon that she knows won’t pass the most minimal health care inspection.
What does a car rating company know about rating Medicaid? The answer is clear. The facts about the J.D. Power survey suggests they know very little. The survey Reynolds is using as her principle defense of privatization is a survey conducted by a for-profit, out-of-state, private company with an obvious financial interest in a positive rating for their Managed Care Organizations (MCO) clients. J.D. Power has been doing commercial product surveys for over 10 years, but this is the first Medicaid survey they have completed. They clearly lack any historical evidence of reliability for this year’s incomplete snapshot of Iowa Medicaid.
Apparently, they questioned less than 60 Iowa enrollees out of a total enrollment of 600,000. Those 60 enrollees were all from just one of the three MCOs, United Healthcare. They didn’t bother to survey any enrollees from the other two MCOs at the time of their August survey. How can a survey based on answers from only one of three companies provide an accurate or honest reflection of satisfaction among all Iowa Medicaid enrollees? We know that the performance levels among the three companies vary dramatically.
Governor Reynolds and J.D. Power refuse to release the actual survey questions, the actual number of Iowans surveyed or who paid for this survey. A telephone call to J.D. Power media office in California confirmed it was paid by their clients and was proprietary information. One can assume their clients are the MCOs surveyed but they refused to identify who they are. Why is Governor Reynolds refusing to release the complete survey and why does she believe this is a credible review? A call to Governor Reynolds office for more information wasn’t returned.
The survey does identify six factors that they used to measure overall satisfaction with their MCOs (listed by order of importance): provider choice; coverage and benefits; customer service; cost; information and communication; and claims processing. They don’t tell us if they are weighted equally or if these are the only criteria they used. They do say that provider choice is a “key driver of member experience,” whatever that means.
Iowa has only two of the original three MCOs left since AmeriHealth abandoned Iowa. Medicaid members now have significantly reduced choices of providers as a result. The 200,000 Iowans that were covered by AmeriHealth just lost their first choice. That hasn’t stopped Reynolds from citing the J.D. Power survey that says provider choice is the key component of that survey.
This week Governor Reynolds’ spokesperson used the J.D. Power survey again to justify Medicaid privatization in response to a letter from Senators Amanda Ragan of Mason City and Liz Mathis of Hiawatha. They asked for an additional 30 days for members who had been covered by AmeriHealth to choose a new provider.
“We are writing to you today to express our grave concerns about Medicaid. The loss of AmeriHealth Caritas and the inability of Amerigroup to take new members leaves too many Iowans without choice,” Ragan and Mathis wrote. “In the name of fairness and choice, we are requesting that you grant an additional 30 days for former AmeriHealth members to choose either United” — United Healthcare of the River Valley — “or the fee-for-service system.”
Reynolds is still relying on the same phony survey that she quoted in her August press release. Following a November 28 Medicaid update by DHS Director Foxhoven, she stubbornly quoted from the J.D. Power survey again. She claimed that privatization has improved access, choices and accountability.
“I’m willing to put the time and the effort into making sure that Iowans get the care that they deserve in a managed and coordinated and more modern delivery system. I’m not going back,” Reynolds declared.
With that statement, in light of months of total Medicaid service chaos, J.D. Power should award Reynolds with best-ever performance as used car saleswoman of the year. Her obstinate doubling down on this horribly dysfunctional Medicaid program puts her management abilities in serious doubt.
DHS conducted a Medicaid public healthcare forum in Des Moines last night with one of the MCOs. The public speakers spent two hours describing Medicaid horror stories including cuts in services, delayed and denied payments, lack of information and little or no accountability. The overwhelming consensus of the forum was a call to return Medicaid to state control.
Reynolds’ Medicaid privatization is broken down and stalled by the side of the road with smoke rising from under the hood. Democrats must elect a new driver capable of steering Medicaid back to compassionate and professional management.
by Rick Smith