The Wrap: Florida’s managed care providers quietly prepping for $70 billion war

by | Sep 5, 2021



Every weekend, we look at the news stories shaping the conversations in Florida’s business, public policy, and political worlds. Here’s this weekend’s Capitolist wrap-up, which we call “The Wrap.”

Managed Care Shenanigans?

There’s been a low murmur on the streets of Tallahassee in the sweltering heat and humidity of the late August summer: subdued chatter over the ultimate healthcare future of an estimated 6.6 million Florida citizens. Government affairs executives, public relations specialists, and their lobbyist counterparts have been quietly prepping plans for a cat-and-mouse game of lobbying one-upmanship over the spoils of a Medicaid managed care procurement fight that is about to unfold in the halls of the capitol complex.

The subject of Medicaid and its related managed care plans may cause eyes to glaze over, but with such a vast percentage of the state’s population dependent on Medicaid programs for their health care, and the 70 billion in federal and state dollars expected to flow into the state to cover the tab, the personal and financial stakes couldn’t be higher. In the past year alone, Florida’s managed care programs have increased by 8.6 percent, or more than half a million new enrollees, far outpacing the state’s population growth. And that growth is only expected to continue for the foreseeable future.

As of right now, the state currently operates 11 regions, with a handful of providers assigned to each region. That program began in 2013, and the state says it’s been highly successful with improved outcomes. But at some point next spring or early summer, Florida is expected to begin the procurement process for a new managed care plan, with the state divided into regions, and awarding contracts to providers in each region in order to provide health services to enrolled families. In 2018, forty providers jumped into a re-procurement process to bid on contracts that were ultimately awarded to just nine providers. In short, the procurement process is extremely competitive, with vast amounts of money at stake, and new procurements don’t come around very often.

Already, mergers and acquisitions have radically altered the landscape in Florida with two of the largest providers, Centene and Wellcare, joining forces last year and forming what one health care analysis described as the “Thanos” of government-focused health plans, a reference to the Marvel Avengers villain who wielded an almost god-like power to snap people into and out of existence. Combined, the two companies now account for more than one out of every four enrollees in the state. Other behemoths also wield considerable power in the Florida marketplace, including Humana, Florida Blue, among several others.

Privately, lobbyists and health care pros in Tallahassee are all saying the same thing: the shenanigans are about to begin. Some of the biggest and smallest players in the business have instructed their teams to do all they can, in the months before the procurement process officially begins, to tilt the playing field as much as possible in favor of their clients. From geographic changes to nearly imperceptible tweaks to algorithms that determine reimbursement rates, the stakes are high. Others will do all they can just to keep a close watch on the moves being made, ready to defend their clients whenever necessary.

As those moves get made, The Capitolist plans to keep a sharp eye out and spotlight the winners and losers in the upcoming legislative process that will begin in only a few weeks.

Democrat Primary Heats Up

In what has so far been a rather boring Democrat primary for governor, Agriculture Commissioner Nikki Fried and Congressman Charlie Crist have largely navigated their campaigns away from direct confrontation. That is, until this week, when Fried used a (likely temporary) abortion ruling by the U.S. Supreme Court to hammer Crist for his previously held beliefs against the practice.

Most voters who know Crist are well aware of his fickle views and track record of changing parties and political positions – but it never hurts to remind everyone that Crist used to be Governor of Florida, then willingly gave it all up for a chance to run for the United States Senate. When that didn’t work out as planned, Crist shifted gears and finally landed a congressional seat. Now, in a very Charlie-like way, he’s shifting gears again and wants his old job back.

The fact that he was once a Republican before he was a Democrat provides no shortage of campaign fodder for Fried to choose from: guns, abortion, immigration, pretty much any wedge issue in modern politics is readily available to her and her campaign team.

Undoubtedly, she’ll have a field day making Democrat voters wonder why they should back his campaign. After all, whatever she believes, at least she doesn’t have a public record to run on beyond her the last two years. Then again, it’s been a relatively rough few years for Fried too, starting with her inability to comply with state ethics requirements by filing truthful financial disclosures.

The primary election is now officially less than a year away. It’s possible things shake out before then, but the next 12 months are going to provide plenty of entertainment for political junkies.

 

 

 

 

1 Comment

  1. Bruce S

    A good article, Brian, about the disgusting scrum coming up in who can get enriched by the poor. I mean that seriously; I’m not just a critic, so you know. 🙂

    Reply

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