The Best and Worst States for Medicaid Managed Care, According to Patients

by | August 18, 2017

By Andy Marso

UPDATE: Since this story was originally published by the Kansas City Star, J.D. Power backtracked from its survey and said that its results from Kansas should not have been included. "The company said it did not survey enough Kansans for a statistically significant result and apologized," the Star reported. "According to a KanCare spokeswoman, J.D. Power surveyed just 10 people about KanCare. The program serves about 400,000."

The original story is below.

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Kansas' privatized Medicaid system, KanCare, came in last among 36 states' managed care Medicaid programs in a customer satisfaction survey conducted by the firm J.D. Power.

The firm ranked patient satisfaction on a 1,000-point scale based on how consumers responded to questions about six areas: provider choice, coverage and benefits, customer service, cost, information and communication, and claims processing.

Kansas was awarded 683 points, leaving it just behind Mississippi's 686 and well behind top-ranked states like Utah (885) and Iowa (859).

Angela de Rocha, a spokeswoman for state agencies in Kansas, said the state would like to see the full survey results and how they were collected, but J.D. Power has not made that information public.

A spokesman for J.D. Power's public relations firm said the company does not release full survey results because it's proprietary information.

Based on the information available, de Rocha said there were several shortcomings with the survey. For example, she said the results could point to statewide problems, like provider shortages, that affect all health insurers in Kansas and not just Medicaid.

"Health plan survey outcomes tend to vary by region and state," de Rocha said via email. "In order to accurately assess consumer satisfaction with KanCare, you would have to be able to compare it with the commercial health plans' consumer satisfaction in this state."

In a separate J.D. Power survey of commercial insurers in the Heartland region, most of the companies that operate in Kansas scored lower in customer satisfaction than their counterparts in Iowa, Missouri, Oklahoma and Nebraska.

De Rocha said the administration also questioned whether J.D. Power had surveyed enough KanCare clients to provide valid results in the Medicaid survey. The sample size of 2,145 people amounts to an average of only about 58 people in each state and Washington, D.C.

In a more comprehensive survey conducted by the federal Centers for Medicare and Medicaid Services, de Rocha said KanCare placed in the top half of state programs for adults and the top quarter of programs for children.

That survey, the Consumer Assessment of Healthcare Providers and Systems, was conducted in 2014. The J.D. Power survey was conducted from January to March 2017.

The J.D. Power survey is another data point in the debate about the quality of a program that has been controversial since Gov. Sam Brownback's administration contracted with three insurance companies to administer all of the state's Medicaid services starting in 2013.

Most states had contracted out some portions of their Medicaid programs by then, but Kansas was the first state to go all in with privatization.

Brownback administration officials have touted the switch as a success story that has reduced state Medicaid costs by $1 billion while improving health outcomes.

Speaking last month at a national convention for lieutenant governors, Kansas Lt. Gov. Jeff Colyer, a plastic surgeon from Johnson County and Brownback's KanCare point person, said it could serve as a model for other states.

But a report published last November by the Leavitt Partners consulting firm determined that KanCare had delivered on the cost savings, but not the quality metrics.

Two months later, CMS denied the state's request to extend KanCare, saying it was out of compliance with some federal regulations and the state had not provided enough oversight of the three insurance companies.

The CMS denial came in the waning days of President Barack Obama's administration, and Colyer called it "politically motivated." The state has reapplied for the extension and is awaiting word from President Donald Trump's administration.

(c)2017 The Kansas City Star (Kansas City, Mo.)