Managed-care executives acknowledge problems, say they're trying to fix them

Executives of three managed-care companies who run most of the state's Medicaid program told a legislative committee yesterday that they are aware of "significant problems" with their management since they took over in November, and they are "committed to fixing them," reports Deborah Yetter of The Courier-Journal. Health-care providers have complained to lawmakers for months about late payments, claims processing and battles over new rules requiring "pre-authorization" to guarantee payment. The executives said they're meeting with providers to solve the problems.

Health care providers implied last week during testimony that the companies were withholding payments to "maximize their profits," Yetter notes. All three executives denied the claim, saying they have to pay interest on payments delayed more than 30 days. They said some late payments "weren't getting past billing clearinghouses" that many health-care providers use to process Medicaid claims. Claims have been delayed in those facilities for a number of reasons, the executives said, including new billing requirements under managed care. They said they are working to identify and pay those claims. (Read more)

Legislators hear from new managed-care firms; lawmaker rates their performance with a show of hands from pharmacists

Kentucky Health News

The three companies recently hired to manage Kentucky's Medicaid program outside the Louisville region defended themselves yesterday against complaints that they are squeezing independent pharmacies to the breaking point. One of the three firms, Kentucky Spirit, fared better in a hearing held by a House-Senate committee before a crowd that included many pharmacists.

When Sen. Vernie McGaha, R-Russell Springs, "asked for a show of hands from pharmacists in the audience to learn which of the three pharmacy-benefits companies they think underpay on generic drugs, nearly everyone raised their hands for Medco Health Solutions, which is Coventry [Cares]'s partner, and Catalyst Rx, which is WellCare [of Kentucky]'s. No one seemed to object to US Script, which is Kentucky Spirit's partner," reports John Cheves of the Lexington Herald-Leader.

Kentucky Spirit is the only firm that continues to pay pharmacists a dispensing fee of $4.50 to $5 per prescription, the rate that had been paid by the state. WellCare pays $3, and CoventryCares $1 to $1.50, the pharmacists told Deborah Yetter of The Courier-Journal. "Pharmacists have told lawmakers at previous hearings that pharmacy-benefits companies sometimes pay less for generic drugs than it costs pharmacies to acquire them," Cheves notes.

Read more here: http://www.kentucky.com/2012/02/13/2067444/medicaid-managed-care-companies.html#storylink=cpy

Rep. John Will Stacy, D-West Liberty, left, whose business interests include co-ownership of at least two pharmacies, got into it with G. William Strein, Medco's vice president for provider relations. "Stacy cut off Strein several times while he was attempting to answer," Cheves reports.

“Why is it fair that you can reimburse us below costs?” Stacy asked Strein, who "disputed Stacy’s assertion and said managed care attempts to strike a balance between its estimated cost of the drug and the costs of the pharmacy to buy and dispense it," Yetter reports. "But that claim was disputed by some of the roughly 30 pharmacists at the hearing who operate independent drugstores. Though the hearing ended before they got a chance to testify, several said afterward that they intended to keep making their case before lawmakers."

Jason Wallace, owner of Grant County Drugs, told Yetter, “It’s a real burden for Kentucky pharmacists. That’s why I’m here.” All the companies told members of the Joint Program Review and Investigations Subcommittee that they are committed to resolving the problems.

"Much of Monday’s testimony was devoted to the complex pricing formula known as the maximum allowable cost, or MAC, that managed care companies consider proprietary," Yetter writes. "Under the Medicaid plan before managed care, the formula was provided to pharmacists, who said they knew what they would be paid. Now, they said, they don’t find out what a company will pay for a specific drug until they file claims. And too often, they say, it’s less than they paid to buy the drug.

“How would you like to go to a gas station and fill your car up with gas and then be told what the charge is?” Breckinridge County pharmacist Jonathan Van Lahr asked after the hearing. (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Don't let food take control of your Valentine's Day!

Trying to avoid, or at least over-indulging in, chocolate and candy on Valentine's Day? Steer clear of making the day about food, experts say.

"Focus on spending quality time with your friends and loved ones," suggests Cristina Harder, a licensed dietician at the Loyola Center for Fitness. "Trying a new activity together is a great way to share time with family and friends."(VirtualChocolate.com photo)

When it comes to eating, cook at home rather than go out to a restaurant, and get some exercise, reports research-reporting service Newswise. In one hour, a person can burn:
• 200 calories walking, ballroom dancing or bowling
• 500 calories playing racquetball
• 600 calories playing tennis

If the celebration just isn't complete with some indulgence, keep track of what it is. Five Hershey's Kisses just have 100 calories, as do 30 plain M&Ms and three Dove dark chocolate hearts. "They will satisfy a sweet tooth without killing a diet," Harder said. "If you do over-indulge, just get back on track as soon as you can," Harder added. "A minor dietary mishap is only a bump in the road and should not derail your efforts." (Read more)

Obama changes health-insurance rule to placate religious groups that oppose birth control

In an effort to quell a firestorm of controversy, President Obama announced today that his administration change its new rule that requires employers to offer free birth-control coverage in their health insurance plans. The rule has outraged some Roman Catholic leaders, whose tenets prohibit artificial contraception. (Associated Press photo by Susan Walsh)

Today's change essentially requires insurers, rather than religious employers, to cover the cost of coverage for contraception. "Any employer who has a religious objection to providing contraception will not have to provide that service to employees, but in those cases the insurer will be required to reach out directly to the employee and offer contraceptive care free of charge," report Christi Parsons and Kathleen Hennessey of the Los Angeles Times.

Yesterday at the Conservative Political Action Conference, Senate Republican Leader Mitch McConnell of Kentucky joined several other speakers in lambasting the original version of the rule, calling it "an assault on religious liberty," reports James R. Carroll of The Courier-Journal.

Obama's adjustment did not appear to placate most critics, but Sister Carol Keehan, president of the Catholic Health Association, said, "The framework developed has responded to the issues we identified that needed to be fixed." (Read more)

Trans fat levels in white adults have fallen by more than half since FDA started requiring labeling of the unhealthy food ingredient

After the Food and Drug Administration required food manufacturers to label how much trans fat is in their products, levels of the unhealthy ingredient in the bloodstream dropped by 58 percent. (Associated Press photo by Ed Andrieski)

The numbers come from a study assessing blood levels between 2000 and 2008. FDA required trans-fat labeling in 2003. Researchers at the Centers for Disease Control and Prevention noted the decline after analyzing blood drawn for the annual National Health and Nutrition Examination Survey, a nationally representative sample of about 5,000 people. The drop was seen in white adults; more research is being conducted to see if it also dropped in other ethnic and racial groups.

"The decline, unusually big and abrupt, strongly suggests government regulation was effective in altering a risk factor for heart disease for a broad swatch of the population," reports David Brown for The Washington Post.

Trans fat is typically used for deep-frying and as an ingredient in baked goods. One study determined "if a person increases total calorie intake 2 percent all in the form of trans fat, risk of heart attack rises by about 20 percent," Brown reports.

"Our findings provide information about the effectively of these interventions," said Hubert W. Vester, a CDC chemist who led the analysis. "This reduction is substantial progress that should lower the risk of cardiovascular disease in people." (Read more)

Companies partner to accelerate adoption of electronic health records in rural hospitals

Anthelio, a health information-technology support company, and Heartland, a hospital information-systems vendor, have partnered to speed up implementation of electronic health records at rural hospitals so the facilities can get federal incentives, reports Ken Terry of Information Week Healthcare. Heartland CEO Angela Franks said the partnership's purpose is to "migrate its customers to a more sophisticated, cloud-based electronic health record system called Centriq . . . as quickly as possible."

Anthelio will provide "migration services," including training and testing and supplement rural facilities' "sparse IT resources." The company expects to bring Centriq to 500 hospitals in two years. Franks said said Heartland focuses exclusively on rural hospitals, providing them with systems tailored to health-care organization in rural places. "Rural America has been largely ignored in terms of what they've done in these small hospitals," she said. "These hospitals go from paper to paperless in 12 months, and they truly are the embodiment of what the country is trying to get to with the electronic health records." (Read more)

Legislators hear about serious problems in managed-care system

The switch to the new Medicaid managed-care system is proving to be a nightmare, health officials told lawmakers Wednesday, with long delays in payment to providers and treatment for patients.

"It appears to me the only place the savings can come from is the delay and denying of care," said Dr. Shawn Jones, president of the Kentucky Medical Association and physician in Paducah. "Patient care is being delayed and, in some cases, simply prevented." (Video from cn|2)

Jones was one of several officials who testified at a meeting of the Senate Health and Welfare Committee. The new system requires pre-authorization for procedures that were once routinely covered, so patients spend hours in waiting rooms or are told to go home and return after their procedures have been given the go-ahead. In one instance, a woman in labor came to the hospital to deliver "and the managed-care company insisted that her care be pre-authorized," reports Deborah Yetter of The Courier-Journal.

"Fourteen days later, mom and baby are home and we still have no pre-authorization," said Joe Grossman, chief financial officer of Appalachian Regional HealthCare.

Problems started Nov. 1 when the state turned its Medicaid program outside the Louisville region to three managed care companies. (Louisville-area recipients have long been managed by Passport Health Plan.) The move is intended to save the state money and fill a hole in the Medicaid budget. But officials said the three companies — CoventryCares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky — seem to be purposefully delaying claims payments, though the state has already paid them $135 million since Nov. 1.

"I feel like I've become a bank to these out-of-state insurance companies," said Grossman, whose eight-hospital chain is owed $8 million. "I've lent them money."

The managed care companies did not testify Wednesday, but issued statements saying they intend to address the issues at hand. Neville Wise, the state's acting Medicaid commissioner, " said he believes the issues are just temporary bumps that can be ironed out," Ryan Alessi of cn|2's "Pure Politics" reports. The requirement that childbirth be pre-authorized, for example, has since been rectified, Yetter notes. State Sen. Julie Denton, R-Louisville, asked Wise, "How many more ludicrous scenarios can there be?" (Read more)