By Jonathan Jantz, MD, FAAP & Rebecca Reddy, MD, FAAP
Recently an area practice discovered that Kancare Managed Care Organizations (MCOs), United and Sunflower have hired third party entities to send out mid-level providers to Medicaid patients’ homes to conduct some sort of assessment. These visits are unsolicited by the patient/family and have never been disclosed to this practice as the primary care provider/medical home. (This has happened at other offices in the state as well. At Cottonwood Pediatrics we thought we had opted out a few months earlier and then it started happening again.)
This practice found out about it when patients complained to providers at visits – many felt coerced and confused. Parents said they were threatened with immediate withdrawal of their children’s Kancare Coverage if they did not allow the mid-level to come to the home to evaluate their child. They were also told or it was inferred to the family that these mid-levels were representatives of this practice, or were visited by a mid-level provider who did not speak the family’s home language so could not communicate at all with the family. (This has been confirmed at other practices in the state.)
With difficulty, United Healthcare Community Plan (UHC) allowed this practice and our practice to “opt out” of this “program.” The practice is still trying to get Sunflower to stop these “home visits” with their patient panel.
This practice contacted the new Kansas Medical Society (KMS) director, Jon Rosell, to see if they could explain. Neither the KMS or the KDHE Kansas Director of Medicaid’s office had any knowledge this was occurring. At this point, after a meeting August 10, KDHE and KMS agreed that communication was poor. It will continue to be poor if they don’t include KAAP in the discussion.
We are investigating now how/why this is happening. There must be something that is motivating UHC and Sunflower (Centene) to conduct these “home visits.”
Regardless, it is disturbing on many levels- as a parent, a pediatrician, and a practice owner.
- First of all, it is a violation of patient privacy and autonomy! Think of it happening to your family– an unknown, unsolicited, provider gets your personal contact information and then coerces their way into your home, and unclothes and examines your child without reason. This should not be allowed to happen.
- Second, it interferes with the true medical home practice and care of patients, and creates complications of care – for example, there are NO immunizations completed at that visit, and yet the paperwork that has come back looks disturbingly like a Well Child Check. So the family/parents do not see a need to go in for immunizations.
- Thirdly, what financial incentives are there? Practices depend upon the family to bring their child at least annually for well visits for obvious reasons of care for children, but it is ALSO one of the few services in a practice that is paid at a respectable rate. Perhaps they are motivated by the “Kancare Health Home” model, which pays impressive amounts to the MCO for working with Medicaid PCP’s. see https://www.pcpcc.org/initiative/kancare-health-homes
Since then, we’ve had a very interesting phone call with Sunflower, who insist that this was an “inventory” of patients’ medications, needs for WCC and need for immunizations. They (Dr. Katie Friedebach, FP and medical director for Sunflower) believe that these visits “drive the patient to their primary care provider.”
We think more often than not it is confusing to patients. They were asked if they would be willing to contract with us (providers) to actually provide the services, since we are in a very good position to do so. Dr. Friedebach responded:
- There may not be enough patients to make it worth their while
- There is a “pay for performance” model she thinks would incentivize us to do this
However, the rates for the SMI/CC visits they might be conducting (we don’t know for sure WHAT program they are doing this under) have pay rates like this:
We don’t know if the above payments are going to the “home visitor.” They are NOT going to the primary care pediatrician.
Since that time, KDHE met with KMS to address this issue (the August 10 meeting mentioned above), but we have not been updated on the outcomes.
We have suggested they needed to do much better communication with KAAP (Kansas Chapter, American Academy of Pediatrics), and Sunflower promised to contact the KAAP director and see if they can work into the Fall meeting in October. That leaves this issue as unfinished at present. If you are seeing this in your practice, please contact me, email@example.com or the KAAP office at firstname.lastname@example.org.