9:45am

Mon February 13, 2012
Health and Welfare

Managed Care Firms Struggle, Lose Some Providers

Since taking over a portion of Kentucky’s Medicaid system, Managed Care Organization (MCO) Kentucky Spirit Health Plan has lost nearly 70,000 members while some healthcare professionals are questioning whether the three new private operators can handle the state’s Medicaid program.

Kentucky Spirit, CoventryCares and WellCare took over Medicaid management last year. Since then, all three have been criticized for delaying payments to doctors and pharmacists. But Coventry Cares and WellCare have slowly increased membership since Nov.1. Kentucky Spirit has dropped from 217,000 members to nearly 140,000.

Joe Grossman is vice-president of Appalachian Regional Healthcare. He recently addressed the Senate’s Health and Welfare committee about the problems with Kentucky Spirit.

“Our view of the most pressing concerns today with the MCOs is network adequacy. And I say that in our region because we have signed agreements with two of the MCOs. We have not reached agreement with Kentucky Spirit,” he said.

The grace period for Kentuckians to switch providers has expired. It’s now up to doctors and other healthcare providers to decide whether they contract with any of the three MCOs.

“A Kentucky Spirit patient arrives in our facility and we treat and stabilize the patient and we inform that we don’t participate with Kentucky Spirit at this time and try to make arrangements and we reached out to two hospitals close-by who were Kentucky Spirit providers and neither one of them agreed to take the patient,” Grossman told the Senate’s Health and Welfare Committee.

Last week, healthcare professionals told lawmakers there were significant problems with the system. Specifically, care providers are owed millions of dollars in claim payments and have struggled to get pre-authorizations for procedures and medications.

Concern about the MCOs being able to pay providers in a timely manner was addressed by Gov. Steve Beshear, who said he isn’t surprised to hear about the problems.

“Look at when Passport first came online you’ll see all of the news reports and they’re the same problems and same kinds of problems we’re having today. Now that doesn’t mean we ought not to be addressing those problems. And we are being very aggressive from the Cabinet stand point and from my administration’s standpoint in looking at each one of those issues and resolving those issues,” he said.

Passport has been in operation for more than a decade in the Louisville area and was a model for establishing the three MCOs that serve the rest of the state.

“I’m confident that we’re going to work through all of these issues,” Beshear said. “This system’s gonna work, it’s worked in other states. It’ll work in Kentucky. And in the process of it we’re gonna save about $365-75 million over the next three years in general fund dollars,” he said.

Lawmakers will hear from the MCOs Monday in a Senate Program Review Committee meeting.

Kentucky Spirit and its parent company Centene Corporation was not immediately available for comment.