A standing-room-only crowd gathered in the Memorial Building's auditorium Wednesday to comment one more time on Gov. Sam Brownback's proposal to transition state Medicaid services to managed care.
Most of the care providers and Medicaid recipients voiced concerns familiar to anyone who has followed the year-long debate over the plan that is set to begin Jan. 1. But Topeka psychologist Ira Stamm found a new way to illustrate his.
Stamm, who said he has been in practice for decades, asked two of the administration's KanCare experts, Health and Environment Secretary Robert Moser and Department on Aging Secretary Shawn Sullivan, to join him at the front of the auditorium and help him act out his vision of the changing relationship between patient, doctor and insurance executive.
Stamm played the patient, pulling over a chair to sit for Moser, a real-life physician who he said he was honored to have as his personal doctor. Sullivan, who played the insurance executive, was initially sent to the opposite side of the stage, where his role was to vet Moser's insurance claim from a distance.
"You know what was wonderful about this?" Stamm said. "This was really private and confidential. There was really a shield or wall between the doctor and patient and the insurance company."
Then Stamm pulled the three of them together to illustrate an increasing interplay in recent decades, with the doctor and insurance company negotiating services and prices and the patient dancing in between.
"Do you guys remember how to do-si-do?" Stamm asked, taking Moser's arm. "I really don't want to embarrass you."
Stamm finished by asking Sullivan to climb up on the stage behind them. Sullivan declined.
Stamm explained that with managed care, he believes the dynamic has changed yet again, with insurance companies now above the other two.
"The insurance companies are looking over the shoulder of the doctors," he said.
The demonstration provided an unusual and at times awkward ending to what was an unexpected opportunity for more public comments on the Medicaid reform plan known as KanCare.
The administration filed for a waiver with the federal government to implement the program in April, but now plans to resubmit the waiver after getting further input from Indian tribes. The refiling required two more public comment sessions -- one in Wichita on Monday and Wednesday's in Topeka.
Moser and Sullivan opened Wednesday's session by laying out again the administration's plan to contract out nearly all state Medicaid services to three private managed care companies, to be chosen among five current bidders. They repeated assertions that the plan will improve health outcomes and slow cost growth without cutting services or provider rates by leveraging private-sector innovation and resources.
The plan is projected to save the state $800 million over five years, and Moser and Sullivan promised stringent quality-of-care oversight, including "pay-for-performance" rewards.
"I can not emphasize this enough," Sullivan said. "Our intention is not to turn over the keys of Medicaid to insurance companies. This will be a partnership."
But a parade of concerned citizens lined up Wednesday to express familiar skepticism. One of the first was Overland Park resident John Turner, who introduced his 35-year-old daughter, Suzanne, who has a developmental disability.
"We see no benefit, at all, for including the DD in managed care," said Turner, who wore a red Special Olympics polo shirt.
The long-term care needs of Kansans with developmental disabilities has been a heated point of contention in the KanCare debate -- to the point where the governor recently agreed to the Legislature's recommendation that those services be excluded from KanCare for the program's first year.
Tom Laing, of Topeka-based Interhab, spoke for those who care for Kansans with developmental disabilities. Laing, like others, praised the administration for soliciting public input, but questioned whether much of that input is being implemented.
"The certainty with which the administration proceeds that this is the right decision, suggests that some of the concerns that have been raised are not regarded as significant as we believe they are," Laing said.
Few of the KanCare opponents expressed alternatives to curbing the burgeoning costs of Medicaid. But Stamm, after finishing his one- act play, put one forward. He recommended Kansas create KanCare as a nonprofit managed care company owned and run by the state, similar to the community mental health company, Kansas Health Solutions. Stamm said that would be preferable to paying out-of-state contractors to coordinate care for Medicaid patients.