It's hard to argue with the wisdom of managed care, at least in theory, as a means of improving efficiency and passing on some of the savings in the form of better health coverage for the clients.

But translating theory into practice is what counts, and the first operational month of the Quest Expanded Access (QExA) healthcare plan for 40,000 Medicaid-eligible patients has been rough.

The state Department of Human Services, which administers the Medicaid program, has been working to get service delivery past roadblocks, from computer glitches that held up prescription medications to confusion about which healthcare providers are in the network.

For the remaining five months in the allotted transition period, DHS must hold its two contractors — Ohana Health Plan and Evercare Quest Expanded Access, affiliates of two Mainland-based for-profit companies — accountable for assigning primary-care physicians through consultation with the patients, without disrupting care.

State officials say that in about 65 percent of the cases — those who are eligible for both Medicare and Medicaid — patients will be able to keep their current physicians. This ought to ease the worries of families who are waiting for their assignments.

Critics of the changeover point with understandable concern to a federal sanction against Ohana's parent company WellCare Health Plans Inc., barring further enrollment of members in its Medicare contract. Although there is no direct connection to the QExA program, these critics are worried that the Medicare flap will weaken the company financially and put its QExA function at risk.

At this point the state, which conducted an evaluation of bids based on various performance parameters, is bound by its contracts and can only monitor to be sure the commitments are met.

But looking ahead, lawmakers should consider a proposed revision to House Bill 1525 that would require all nonprofit and for-profit firms that seek contracts under the state's Medicaid, QUEST or QExA programs to provide a range of business data to help guide contract evaluations.

This is sensible. The state needs latitude in drawing health plan providers to the Hawai'i market, but it also needs information to see that its people are served well.