Members of a panel working to reduce infant mortality today got their first, limited look at the prenatal programs coming under KanCare — and many expressed apprehension at what they've seen so far.
"I see some problems. The first is that there's three different programs, and each one is different," said Dr. Dennis Cooley, chair of the Kansas Blue Ribbon Panel on Infant Mortality, at the panel's quarterly meeting. "How are they going to coordinate with our community programs who are already providing services?"
Cooley and other panel members were reacting to presentations on the basics of prenatal care to be offered by the three for-profit insurance companies awarded contracts under KanCare.
KanCare is Gov. Sam Brownback’s plan for shifting virtually all of the state's 380,000 Medicaid enrollees into managed care plans to be run by United Healthcare, Amerigroup and Sunflower State Health Plan, a subsidiary of Centene.
The new program is scheduled to start Jan. 1, pending federal approvals.
About 6,700 pregnant women and 17,200 infants were enrolled each month on average in the state's Medicaid program last year.
The panel on infant mortality was formed by then Gov. Mark Parkinson in 2009 to address the state's unusually high infant death rate. Kansas' death rate for all babies is 6.3 deaths per 1,000 live births; the national average is 5.6. The state's death rate for black infants is the worst in the nation, at 19.6 per 1,000 live births.
After each of the three presentations — two of which were delivered by phone — panel members quizzed the company representatives, particularly about their intent to work with the patchwork of locally based, mother-and-child programs throughout the state.
No such details were offered today. A response by Karen Shea from Amerigroup was representative:
"I'm not prepared to go that deep into how this is all going to work. But most — if not all — of what I've talked about is something that's provided telephonically to the member. If we need a home visit, then I'm assuming this is something we would work with your team on. But how we would reimburse you for it, whether you're eligible for reimbursement, all of that — we'd have to work out the details," Shea said via teleconference.
Following the presentations, panelists discussed what they had heard. Panel member Susan Wilson suggested a representative from the Kansas Department of Health and Environment be appointed to work out the details of how its Maternal and Child Health programs would work under managed care.
"When we hear them say 'We'll call you,' or that they'll get with us individually, that's really really frightening," said Wilson, director of the Sedgwick County Healthy Babies program.
"If we have to adapt to meet the changes that are coming down, we're willing to do that. But when do we start getting some answers about what things are going to look like? Is it just going to be that, as of Jan. 1, any fee-for-service revenue we're getting in is just going to stop?" Wilson said. "How is this going to affect our federal Healthy Start funding and all of our other funding streams? I'm really worried."
Panel member Jon Rosell — director of the Medical Society of Sedgwick County — said he was skeptical that the three managed care companies would improve health care delivery.
"I think it's just going to fracture and discoordinate the care that's already trying to be delivered," Rosell said.
Infant Mortality Review update
In other business, panel members were updated on progress in implementing the Fetal and Infant Mortality Review (FIMR) in three counties.
FIMR programs collect data related to infant deaths, including environmental information learned from interviews with mothers who recently have had a baby die. The program then uses the information gathered to analyze and address community-specific causes of deaths.
Two foundations plan to grant nearly $900,000 over five years to three of the five counties with the state's highest infant mortality rates: Geary, Reno, Saline, Shawnee and Wyandotte.
A request for proposals from the counties is due Sept. 28. Selected counties will be notified Nov. 16.
The grants will be provided by the United Methodist Health Ministry Fund and the Kansas Health Foundation, which is a major funder of the Kansas Health Institute.
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