Advisor role in exchanges causes clash | LifeHealthPro

Advisor role in exchanges causes clash | LifeHealthPro.

Catania defends health care for illegal immigrants as Gray signals opposition

Catania defends health care for illegal immigrants as Gray signals opposition

May 05, 2012 — 7:43 PM, Alan Blinder, Examiner Staff Writer

A D.C. councilman’s plan to allocate an extra $20 million to health care for illegal immigrants — a move that defied Mayor Vincent Gray’s 2013 budget proposal — has drawn sharp criticism from the mayor’s office and set the stage for what could become a pitched battle between the city’s legislative and executive branches.

"We are seriously worried that the [at-large Councilman David] Catania plan takes critical money from one program and shuffles it to another program," Gray spokesman Pedro Ribeiro told The Washington Examiner. "He hasn’t found any new money. He’s just creating holes in other places."

In an internal memorandum obtained by The Examiner, city officials said Catania’s plan "selectively grabs ‘savings’ from line items in the Department of Health Care Finance’s budget."

But Catania said that wasn’t true.

"We have enough resources to provide decent health care to everyone who lives here," Catania said. "I believe very strongly that we ought not to treat immigrants differently than other residents of our city."

On Thursday, the council’s health committee, which Catania chairs, announced it had found enough money to provide hospital care to participants in the DC Healthcare Alliance, a city health insurance offering that mostly caters to illegal immigrants who aren’t eligible to participate in federal programs.

The panel said it balanced the program’s new budget by, in part, controlling personnel costs and correcting estimates for enrollment.

Confronted with another budget shortfall, Gray had proposed slashing the program’s funding and transferring more of the costs of caring for illegal immigrants to the federal government. But that plan, which Gray unveiled in March, drew quick criticism from Catania, along with a vow to restore the dollars.

Even though the council came under harsh criticism last week for failing to approve a plan to pay District workers for furlough days they were forced to take in 2011, one union leader said the decision to move forward with the health care funding didn’t bother him.

"I’m never going to pit employees and their concerns against other legitimate concerns," said Geo Johnson, the executive director of the American Federation of State, County and Municipal Employees’ affiliate in the District. "I don’t advocate that at all."

Sale of D.C. health-care firm in works

Sale of D.C. health-care firm in works

By Nikita Stewart and Mike DeBonis, Washington Post, Monday, May 7, 9:13 PM

D.C. Chartered Health Plan is weighing offers from buyers in an effort to keep $350 million in District government business that officials have said it could lose if the company remains in the hands of owner Jeffrey E. Thompson.

Chartered’s efforts to reorganize with such a sale could be finalized as early as this week, said people familiar with the matter who were not authorized to speak publicly about the negotiations. The transaction would separate the managed-care firm from Thompson, who recently resigned as board chairman after a March raid on his home and offices in a federal probe into alleged campaign-finance violations.

The company’s contract to manage the health care of low-income city residents expires in May 2013, and bids for a new contract must be in by July 31, said Wayne Turnage, director of the District’s Department of Health Care Finance. Should Thompson pursue a sale, the transaction would also have to be approved by city insurance regulators, a process that would take at least a month.

D.C. Council member Yvette M. Alexander (D-Ward 7) said she was impressed by a potential new ownership scenario that would make Chartered a subsidiary of Philadelphia-based AmeriHealth Mercy, which touts itself on its Web site as “the leading group of Medicaid managed care plans and related businesses in the United States.”

Alexander said Maynard G. McAlpin, Chartered’s chief executive, could be the new owner of Chartered. The Washington Post previously confirmed with Chartered that McAlpin was moving to take over as the new owner.

Karen Dale, a spokeswoman for Chartered, said it “would be premature, at this time, to discuss any potential transaction” involving the company.

Michelle Davidson, AmeriHealth Mercy’s communications director, declined to confirm any negotiations. “While AmeriHealth Mercy Family of Companies always monitors the market and regularly evaluates opportunities to prudently expand our business, we do not comment on rumors or speculation,” she said. “We cannot comment further at this time.”

Chartered is still looking at other firms, said one of the people with knowledge of a potential sale.

Thompson will have to move quickly to seal a deal before the bidding deadline. The D.C. Department of Insurance, Securities and Banking must review any sale to determine “whether the acquiring entity has the financial wherewithal and expertise” to operate as a health insurer, said agency spokeswoman Michelle Phipps-Evans.

That process, she said, can happen in as little as 30 days, “but typically there is additional information required . . . and the process takes longer.”

Alexander said she met with McAlpin and Anne Morrissey, AmeriHealth’s executive vice president and chief operating officer, about two weeks ago and they unveiled the potential partnership.

Morrissey is a District native who received her nursing degree from Washington Hospital Center School of Nursing.

Chartered has been a major employer of District residents, and Morrissey emphasized that “it was important to also keep the operation local,” said Alexander, who oversees insurance issues as chairman of the Committee on Public Services and Consumer Affairs.

“She grew up in Southeast. She went to school in the area. She is local,” Alexander added. “She is familiar with this area. [AmeriHealth Mercy] is in a lot of different areas of Medicaid.”

A bidder for the new contract, among the city’s largest, would have to be able to manage the health care of Chartered’s 110,000 members. The city has aimed to have several strong companies under contract competing to serve residents enrolled in the Medicaid and D.C. Healthcare Alliance plans, but Chartered has developed a near monopoly. Now, with Thompson’s legal troubles and the firm’s recent operating losses, Chartered’s hold on the D.C. contract — its sole source of business — is threatened. Turnage told a D.C. Council committee last month that it was unlikely Chartered would keep the contract if Thompson remained in charge.

Council member David A. Catania (I-At Large), chairman of the Health Committee, said AmeriHealth Mercy “has a stellar reputation, from what I know.” But he said he has purposely not met with any potential buyers for Chartered, saying he did not want to be seen as interfering in the impending contract solicitation.

Catania, who previously acknowledged that it would be difficult for Chartered to keep its city contract with Thompson as owner, said a sale could represent a fresh start for the company.

“If the company’s owned by a reputable health insurance company that can actually build a network of high-quality physicians and actually manage the care of our residents, that’s all that’s of concern to me,” he said, adding, “I want to get away from the notion there’s anything personal.”

D.C. Council member Catania comes up with $20M for health coverage for illegal immigrants

D.C. Council member Catania comes up with $20M for health coverage for illegal immigrants
By Tim Craig, May 3, 2012, Washington Post

D.C. Council member David A. Catania has found an additional $20 million in the budget to continue offering free health insurance to 19,000 undocumented immigrants, reversing a proposal by Mayor Vincent C. Gray (D) that could have restricted them from receiving emergency care.

Catania (I-At Large), chairman of the council’s Health Committee, has made full funding of the Alliance Insurance program a chief priority as the council prepares for final budget deliberations.

But the council would be restoring the health insurance program at the same time it is scaling back other government services, including millions in services for the poor, potentially sparking fresh debate about whether city benefits for undocumented immigrants are too generous.

When the Health Committee convened on the budget Thursday, Catania announced that he and his staff had found $20.5 million in savings by eliminating some vacant positions, recalculating Medicaid enrollment and transferring some funds between Health Department units.

The five-member Health Committee unanimously approved Catania’s plan to transfer the money to immigrant health care. The full council is expected to accept the agreement when it votes on the budget later this month.

“The mayor’s proposal would have treated immigrants differently,” Catania said in an interview. “I believe, for us in this city, it was critically important we reject that.”

Gray had proposed scaling back the Alliance program to balance his 2013 spending plan by shifting some of the burden for immigrant care onto hospitals and federal programs for uncompensated care.

Created in 2001 after D.C. General Hospital closed, the Alliance Insurance program provides coverage to residents who earn too much to qualify for Medicaid but not enough to be able to afford private insurance.

But following the 2010 passage of President Obama’s health-care legislation, which boosted Medicaid eligibility, the city was able to transfer thousands of residents into the federal program.

Now, about 99 percent of residents covered by locally funded insurance are undocumented immigrants who are not eligible for federal benefits.

Catania said preserving the program this year was a crucial and symbolic step in the nationwide battle over immigration and health care.

“It’s big America versus small America,” Catania said. “I gravitate toward the notion of big America. Big America is one who welcomes people who want to work.”

If the program is cut, Catania said, undocumented immigrants would not be covered for specialty or emergency care at many area hospitals. But Gray had argued the patients would still receive care through funds hospitals establish to provide services to the uninsured.

A Gray spokesman said the administration is reviewing Catania’s proposal.

Catania’s decision comes as the council has been struggling over whether the city can afford to repay its employees a combined $22 million for furlough days they were forced to take last year. By fully funding the Alliance program, public employee unions are likely to put renewed pressure on the council to come up with the money.

For Catania, however, cutting Alliance would be a setback to his long-held goal of offering universal health insurance in the District.

In 2010, the city estimated that only 6.2 percent of District residents were uninsured, less than half the national average and lagging behind only Massachusetts in total percentage of uninsured residents.

The District was only able to achieve those rates by extending coverage to undocumented immigrants, Catania said.

“This is a rich city, and we have the resources,” said Catania. “We ought to be a leader, and not a follower, and showing the rest of the country this is America.”

DC Health Reform e-Newsletter

Issue 1

May 2012

Want a giant D.C. government health care contract?

Posted at 05:54 PM ET, 04/24/2012

Want a giant D.C. government health care contract?

By Mike DeBonis, Washington Post

Thompson’s days in the health care business could be numbered. (C-SPAN)

The D.C. Department of Health Care Finance today issued a solicitation for new contractors to manage the care of the 165,000 city residents in publicly financed health programs.

This is notable for two reasons: First, the sheer amount of money at stake is enormous. Upwards of $600 million in local and federal funds will be spent via these contracts. Second, it means Jeffrey E. Thompson’s days in the health care business might officially be numbered.

Recall that Health Care Finance Director Wayne Turnage told a D.C. Council panel last week that it would be “unlikely” that Thompson’s Chartered Health Plan would hold on to its contract as long as he remains its owner.

The current managed-care contracts are set to expire in May 2013.

Thompson has been under a microscope since federal agents raided his home and offices last month, revealing his role in an ongoing probe of campaign finance in the city.

Chartered’s CEO has told the city he’s seeking to purchase the company from Thompson, and now the clock starts ticking on consummating a deal.

If Thompson can’t unload the company before the solicitation expires — a complicated process that includes approval from insurance regulators — Chartered’s value would be questionable, considering the D.C. managed-care contract is its sole source of business. (For a more detailed overview of the considerations at stake, check out Ben Fischer’s Friday piece in the Washington Business Journal.)

The solicitation lists a deadline date of May 18 for the submission of proposals, but Turnage said Tuesday that date would likely be extended “to better manage the selection process internally.”

The question is, besides Chartered and the city’s other current contractor, UnitedHealthcare, who will respond? Turnage said last week at least three bidders, including health care firms with a “national profile,” had expressed some interest.

Health Exchanges Have Fans in Some States

Health Exchanges Have Fans in Some States

By LOUISE RADNOFSKY, Wall Street Journal

A handful of states say they are planning to press ahead and voluntarily implement a key part of the 2010 federal health-care law even if it is wiped out by the Supreme Court.

The Obama administration’s law faced three days of skeptical questions from the court’s conservative majority this past week, increasing the odds that part or all of the law will be struck down. The justices met Friday for their weekly conference, where they were expected to take a preliminary vote and decide how to issue their written opinions on the case, but they aren’t expected to announce their decision until late June.

The health-care overhaul requires that all states have a new insurance exchange where consumers can comparison-shop for policies. The law calls for them to operate like travel websites that sell airline tickets, allowing people to stack up policies next to each other and get plan details in simple terms.

The exchanges, set to take effect in 2014, are one of the most popular parts of the new law. States can run their own exchanges or let the federal government do it for them.

Officials in Rhode Island, California and Colorado—states where governors are broadly supportive of the law—say they plan to move ahead with their exchanges even if the entire law gets struck down. They added that they expect the law will remain in place, and are working to meet the 2014 deadline to get exchanges up and running.

"You can crystal-ball yourself to death," said Peter Lee, the executive director for the exchange in California. "If the unthinkable became thinkable, there are members of the state legislature, there’s an exchange board, there are constituents across the state who would say, ‘OK, now’s the time to take the next steps.’ "

Lawmakers in California have floated the idea of introducing a statewide requirement for individuals to carry insurance or pay a fee. Massachusetts is currently the only state to have this requirement.

Associated Press

Rhode Island Democratic Lt. Gov. Elizabeth Roberts, above right, sees ‘a role for an exchange here.’

Rhode Island officials, too, said they were pressing ahead with their state exchange and would also consider passing state-level legislation to substitute for parts of the federal law if they are struck down.

"There’s a role for an exchange here…and that can happen no matter what happens with the Supreme Court," said Democratic Lt. Gov. Elizabeth Roberts, who has been overseeing Rhode Island’s health-overhaul efforts.

Ms. Roberts said she had pushed legislation three years ago to create a state requirement to purchase insurance or pay a fine. She said she would be prepared to do it again, if necessary.

While states could still create their own exchanges if the whole law fell, they wouldn’t get the law’s federal funding to run them, or the federal subsidies designed to help lower earners buy coverage in the exchanges.

The executive director of the Colorado exchange, Patty Fontneau, said the legislation creating the state’s exchange explicitly banned officials from using state funds to prop it up, and that funds from private companies or foundations might be options for keeping it going.

She said that as officials consider applications from vendors to provide the technology to run the exchange, they are discussing the importance of being able to adapt to a different landscape.

"The deadlines are so tight that we are continuing to move forward, because we have to be flexible, and we realize…we can’t really stop and wait to see what happens in June," she said.

Most states have taken federal money to begin establishing their own exchanges, though they are at varying stages in the process. In all, the U.S. has given out around $730 million in set-up funds to date. A few states have turned away all funds.

Some Republican-led states, which have opposed the health-care law but have moved ahead with their exchange preparations just in case, said they would likely halt their efforts if the court overturns the law.

"We’re prepared to stop at any time, or to consider moving forward," said Seema Verma, a health-policy consultant for Indiana GOP Gov. Mitch Daniels.

A spokesman for Florida GOP Gov. Rick Scott said the state would comply with the law if it is upheld, but that officials would "cross that bridge when we come to it." Florida has turned away federal money to create its exchange.

Lane Wright, the spokesman, said the governor’s administration was "confident" the law "will be ruled unconstitutional, and so we’re not very concerned how these exchanges would be set up."

Write to Louise Radnofsky at louise.radnofsky

A version of this article appeared Mar. 31, 2012, on page A5 in some U.S. editions of The Wall Street Journal, with the headline: Some States Want Health Exchanges.

CareFirst to give $8.5 million in grants to safety-net clinics

CareFirst to give $8.5 million in grants to safety-net clinics
By Lena H. Sun, Washington Post, February 28

CareFirst BlueCross Blue­Shield, the largest private insurer in the Washington region, plans to announce Tuesday that it will give $8.5 million to a dozen safety-net clinics to help them use a coordinated primary-care approach to treat their most vulnerable patients, executives said.

Over the next three years, the funded programs are expected to treat as many as 66,000 patients with costly chronic illnesses such as diabetes, heart disease and high blood pressure. The clinics are in Maryland, Virginia and the District.

The initiative expands on an approach known as the patient-centered medical home, which is being tested in dozens of public and private experiments across the country as part of the health-care overhaul. Federal policymakers are watching closely to see whether the strategy can improve care and reduce costs.

Instead of doctors waiting to see patients mostly when they have a specific problem, a team of doctors, nurses and other staff members aims to take care of the whole person on a continuing basis, with an emphasis on prevention and comprehensive care, often targeting the sickest patients. The strategy is expected to translate into better care and fewer emergency visits, hospital stays and trips to specialists, clinic officials said.

Many of the experiments are taking place in privately insured networks. CareFirst, with 3.4 million members, has been conducting one of the largest of its kind in the Washington area since January 2011. About 3,100 doctors, or 81 percent of the region’s actively practicing primary-care physicians, are participating in the program, according to Chet Burrell, CareFirst’s chief executive.

The program uses a team approach and relies on a host of financial incentives to encourage doctors to increase the emphasis on helping their sickest patients. Doctors who join the program receive a 12 percent increase in their insurance reimbursements, $200 for each detailed care plan they set up for a patient, and additional fees for improving quality and reducing overall cost.

In the initiative to be announced Tuesday, CareFirst will provide grants to the safety-net clinics to jump-start their own programs. CareFirst will also give technical support and guidance on electronic health record systems, clinic officials said.

Clinics were asked to submit proposals and were chosen based on how well they could coordinate care for the most needy patients.

“We’re not paying for the care, we’re paying for the coordination,” Burrell said.

One of the recipients is the Arlington Free Clinic, which provides free health care to about 1,600 low-income, uninsured residents. The clinic will receive about $350,000 over three years, roughly a third of the total cost of the program, said Nancy Sanger Palleson, the clinic’s chief executive.

The clinic will use the money to hire additional personnel and upgrade electronic medical records to allow the staff to better track the care of “the sickest of the sick” — about 160 people — she said.

For example, medical assistants could make sure the necessary bloodwork is completed before a patient’s appointment with a specialist, Palleson said. “Otherwise it would be a wasted trip for her and for the physician, who could be seeing someone else.”

With 140 affiliated doctors providing their services free, she said, “the more efficiently we can use them, the more people we will be able to see down the road.”

And the need appears to be growing. The clinic takes new patients through a monthly lottery system. Typically, about 120 show up for the lottery, and the clinic takes 25 of them, Palleson said — but last week, for the first time, 220 people showed up. “We could only take 25,” she said.

The other clinics include Mary’s Center and Unity Health Care in the District, the Spanish Catholic Center in D.C. and Maryland, and Community Clinic Inc. and partner Greater Baden Medical Services in Montgomery County and Prince George’s County.

Experts say the key will be whether the clinics can sustain the programs over time. “The kind of people who have complex medical problems as well as social and economic issues might be the people who would benefit most by this kind of initiative,” said Judy Feder, a health-care expert at the Urban Institute.

Those patients are most likely to “fall prey to the inappropriate use of health care, whether on the back end with preventable high-cost hospital admissions or on the front end with insufficient primary care,” she said.

Leveling the playing field will be even more important in the run-up to 2014, when primary-care doctors will be in greater demand as insurance coverage expands to millions more Americans, experts said.

United Medical Center seeks $15 million from the D.C. government

United Medical Center seeks $15 million from the D.C. government

By Tim Craig, Washington Post, Published: February 16

United Medical Center is requesting an additional $15 million from D.C. taxpayers to help finance a turnaround, likely renewing debate about whether the city should own a cash-starved hospital.

After its previous owners defaulted on its obligations to the city, the District took over the Ward 8 hospital in December 2010 until a new operator could be found. But the city government is divided over whether the city should try to quickly unload the hospital to a private buyer or keep it to try to bolster its quality — and its price tag.

With the latter camp prevailing so far, the hospital’s board of directors wrote Mayor Vincent C. Gray (D), requesting additional funds to help United Medical rebrand its mission by shifting to “ambulatory and physician-centric care.’’ The hospital, formerly known as Greater Southeast Medical Center, specializes in traditional acute care.

The board is asking the District for an additional $9 million in direct funding, as well as to forgive a $6 million loan. The board will also seek $5 million in federal funds.

“The Board, hospital management, and [the Office of the Chief Financial Officer] leadership met to collaboratively determine the financial support needed to maintain hospital operations and fund the restructuring effort,” wrote Bishop C. Matthews Hudson, chairman of the board. “We came to a consensus that $15 million will be required.”

Gray said in a statement that he would “carefully review” the request “to determine the best response for the benefit of UMC, the District residents it services, and the city as a whole.”

Serving a limited number of clients with private insurance, the hospital has been plagued by financial problems for years. But as the only hospital east of the Anacostia River, D.C. Council member David A. Catania (I-At Large) and other city leaders have repeatedly stepped in to prevent it from closing.

The District invested $79 million in the hospital in 2007 as part of a deal to keep it from closing by selling it to Specialty Hospitals of America, a for-profit company. Specialty struggled to make it payments, citing low Medicare reimbursement rates. In 2010, the District took over the hospital after Specialty defaulted.

Catania, chairman of the health committee, has become a chief advocate for keeping the hospital under public control.

Chief Financial Officer Natwar M. Gandhi has suggested a quick sale. Although Gray agrees broadly with Gandhi’s concerns, he has signaled that he is willing to give the hospital time to stabilize its finances.

In October, a report by the Department of Health Care Finance recommended that the hospital readjust its mission so it can compete better. Citing the report, Gray then requested that the hospital focus more on ambulatory care before it is put up for sale.

Hudson said in his letter that additional money is needed to work toward Gray’s suggestion, including the hiring of a “turnaround consultant.”

“We are not just asking for money,” Hudson said in a brief interview. “There is a purpose to move the hospital forward.”

Hospital officials note that the facility’s finances have improved since the city takeover, including an estimated $2.5 million profit in the fiscal year that ended Sept. 30.

“If you want to make improvements, you have to invest in capital and . . . this proposal appears to do that,” Catania said through a spokesman, Brendan Williams-Kief.

But the hospital’s request could spark a fierce debate on the D.C. Council.

On Tuesday, Catania got into a profanity-laced shouting match with council member Marion Barry (D-Ward 8) when Barry tried to question Gandhi on the hospital’s finances.

Barry, however, endorsed the turnaround plan on Thursday. “We are not going to let the hospital fail,” he said.

United Medical Center seeks $15 million from the D.C. government

United Medical Center seeks $15 million from the D.C. government

By Tim Craig, Washington Post, Thursday, February 16, 8:47 PM

United Medical Center is requesting an additional $15 million from D.C. taxpayers to help finance a turnaround, likely renewing debate about whether the city should own a cash-starved hospital.

After its previous owners defaulted on its obligations to the city, the District took over the Ward 8 hospital in December 2010 until a new operator could be found. But the city government is divided over whether the city should try to quickly unload the hospital to a private buyer or keep it to try to bolster its quality — and its price tag.

With the latter camp prevailing so far, the hospital’s board of directors wrote Mayor Vincent C. Gray (D), requesting additional funds to help United Medical rebrand its mission by shifting to “ambulatory and physician-centric care.’’ The hospital, formerly known as Greater Southeast Medical Center, specializes in traditional acute care.

The board is asking the District for an additional $9 million in direct funding, as well as to forgive a $6 million loan. The board will also seek $5 million in federal funds.

“The Board, hospital management, and [the Office of the Chief Financial Officer] leadership met to collaboratively determine the financial support needed to maintain hospital operations and fund the restructuring effort,” wrote Bishop C. Matthews Hudson, chairman of the board. “We came to a consensus that $15 million will be required.”

Gray said in a statement that he would “carefully review” the request “to determine the best response for the benefit of UMC, the District residents it services, and the city as a whole.”

Serving a limited number of clients with private insurance, the hospital has been plagued by financial problems for years. But as the only hospital east of the Anacostia River, D.C. Council member David A. Catania (I-At Large) and other city leaders have repeatedly stepped in to prevent it from closing.

The District invested $79 million in the hospital in 2007 as part of a deal to keep it from closing by selling it to Specialty Hospitals of America, a for-profit company. Specialty struggled to make it payments, citing low Medicare reimbursement rates. In 2010, the District took over the hospital after Specialty defaulted.

Catania, chairman of the health committee, has become a chief advocate for keeping the hospital under public control.

Chief Financial Officer Natwar M. Gandhi has suggested a quick sale. Although Gray agrees broadly with Gandhi’s concerns, he has signaled that he is willing to give the hospital time to stabilize its finances.

In October, a report by the Department of Health Care Finance recommended that the hospital readjust its mission so it can compete better. Citing the report, Gray then requested that the hospital focus more on ambulatory care before it is put up for sale.

Hudson said in his letter that additional money is needed to work toward Gray’s suggestion, including the hiring of a “turnaround consultant.”

“We are not just asking for money,” Hudson said in a brief interview. “There is a purpose to move the hospital forward.”

Hospital officials note that the facility’s finances have improved since the city takeover, including an estimated $2.5 million profit in the fiscal year that ended Sept. 30.

“If you want to make improvements, you have to invest in capital and . . . this proposal appears to do that,” Catania said through a spokesman, Brendan Williams-Kief.

But the hospital’s request could spark a fierce debate on the D.C. Council.

On Tuesday, Catania got into a profanity-laced shouting match with council member Marion Barry (D-Ward 8) when Barry tried to question Gandhi on the hospital’s finances.

Barry, however, endorsed the turnaround plan on Thursday. “We are not going to let the hospital fail,” he said.

Follow

Get every new post delivered to your Inbox.