solution,” said Spedale. Gordon agreed that he would
rather not see the state experiment with an insurance-
based model, citing the failure of similar plans in other
states. However, he said if they have to participate in the
proposed model, the physicians would be likely to put
together a shared plan if it was financially feasible. “There
is less risk in a shared model, but the money is in the pre-
paid model,” said Gordon. He said the state plans to weigh
the two models against each other, to see which companies
are doing the best and probably retain those. “It basically
gives the whole Medicaid budget to an experiment, which
we think is a little risky,” said Gordon.
Coalition members would have liked to have seen instead
further enhancement of the current Community Care net-
works which they say were working despite claims to the
contrary. While the program, which was initiated back in the
1980s was gaining steam and producing outcomes, it had
been allowed to sit stagnant for the last few years, said
Gordon. Many providers see the program as worthy of con-
tinuation and further enhancement, at the very least as a
stopgap measure, while a more long-term Medicaid solu-
tion is developed.
Spedale and Gordon feel the coalition has been successful
in incorporating some changes in the states coordinated
care network design, concerning things like network ade-
quacy and payment floors, but they still object to the basic
design. “Its one of those things where if you dont agree
with the basic premise, which is what we dont agree with,
and then you make changes to whats being proposed,
Stewart Gordon, MD