• Maintained health outcomes at or above the national average for the majority of indicators and improved outcomes for recipients through financial incentives.
• Achieved patient satisfaction levels above the national averages of other state Medicaid programs and even commercial health maintenance organizations.
• Restrained costs, flattening the cost curve for per-person spending.

Describing a "tectonic shift from central state management," Tarren Bragdon, the study's author, said the pilot program gives patients "a meaningful choice of multiple private plans, which offer varying sets of benefits and various provider networks."

Additionally, Bragdon found "an innovative monetary rewards system that encourages and incentivizes patients toward healthy, responsible behavior in managing and improving their own health."

"In the old system, the state simply paid claims, leaving taxpayers to pay hundreds of millions of dollars per year in fraud and abuse," Bragdon wrote.

Under the reform pilot program, the private marketplace absorbs the risk as the state shifts to paying premiums rather than using the fee-for-service system.

Currently operating in Broward, Duval, Baker, Nassau and Clay counties, the pilot serves a mixture of urban and rural Medicaid patients.

Participation is mandatory for low-income families and children and for those eligible for Medicaid who were receiving Supplemental Security Income (the elderly and those with disabilities).

The 290,000 covered Medicaid recipients total more individuals than the Medicaid programs in 17 states.

"If Florida’s Medicaid reform pilot experience were replicated nationwide, Medicaid patient satisfaction would soar, health outcomes would improve, and Medicaid programs could save up to $91 billion annually," Bragdon estimated.

Not so fast, say the Florida Hospital Association and a state association of nurse practitioners.

"Medicaid isn't designed for health plans to make a profit," said Bruce Rueben, CEO of the Florida Hospital Association.

"There's no lesson in Florida that other states should look to. They should design their own delivery systems based on unique and special circumstances."

Rueben recalled that "a lot of HMOs abandoned the Florida market" in the initial years of the Medicaid pilot program. He said that situation has stabilized somewhat as provider service networks picked up the slack.

"It's better than it was, but it's been hit and miss," he said.

Rueben said that from an acute-care perspective, the FHA continues to work as a partner with the state.

"As long as there's full accountability and transparency that every organization plays, it can be effective," he said.

"You have to know where the money goes, all along the way. And you have to make sure people truly have access to care. That's what the taxpayers are paying for."

The state currently spends more than $22 billion a year on Medicaid, the second largest budget item after education.

Though the Medicaid reform pilot was approved by large bipartisan majorities at the Legislature, critics objected to provisions that allow private managed-care companies to add or limit benefits, expand provider networks, revise drug formularies and incentivize healthy behaviors.

A Georgetown University study released in April declared that “much critical information is still lacking about the impact of Florida’s Medicaid pilots, including whether or not the pilots have saved money -- and if they have, whether the savings came at the expense of needed care.”