LACONIA — Senior executives of LRGHealthcare welcome both the introduction of Medicaid managed care and the expansion of Medicaid enrollment, which they believe offer opportunities to improve the quality and control the cost of care while placing the corporation on a sound financial footing.
Tom Clairmont, president and chief executive officer, said yesterday that the changes in the offing will strengthen the ability of his company to pursue its mission of providing superior medical care to all members of the community. He explained that expanding Medicaid enrollment and establishing insurances exchanges would increase appropriate access to health care by reducing the numbers without insurance.
"It will put people on an equal footing by ensuring their access to primary care physicians," Clairmont said, "not just to the emergency room." He recalled that when Healthlink opened in 1993, it provided access to 3,500 families and reduced visits to the emergency room by half.
This spring LRGHealthcare entered agreements with the three managed care providers that will administer the state's Medicaid program — Boston Medical Center Health Plan, Inc., Centene Corporation and Meridian Health Plan. Henry Lipman, senior vice-president for Financial Strategies and External Relations, described managed care as the essential infrastructure for administering an expanded Medicaid program. "By contracting with all three managed care companies we're offering the maximum choice," he said.
At the same time, LRGHealthcare is one of 13 hospital companies participating in the health care exchange, through which those earning between 139-percent and 400-percent of the federal poverty level can purchase subsidized health insurance from private carriers. Currently Anthem is the only carrier participating in the exchange with three different plans, but Harvard Pilgrim, perhaps along one or more of the managed care companies, will join by 2015.
Lipman estimated that expanding Medicaid to enroll those with incomes of 138-percent of the federal poverty level would add approximately 6,000 patients to the rolls of LRGHealthcare. He anticipated that the corporation would serve another 3,000 or 4,000 who receive insurance through the exchange.
Andy Patterson, senior-vice-president for Provider Relations and Contracting, said that "we're seeing many of these patients already." However, he said that much of this population, rather than undergoing a regimen of continuing care, is seen only when their conditions become acute, requiring costly treatments and interventions. With insurance, Patterson said, these patients will have access to continual care, reducing the need for acute care, costly treatments and repeated visits.
Lipman said that extending access to this population would "bend the cost curve," stressing that utilization of services is a primary driver of rising costs. He noted that to reduce excessive utilization the Center for Medicare and Medicaid Services (CMS) has begun penalizing hospitals with high readmission rates and said that LRGHeathcare is among those not to have been penalized. Patterson attributed the success to "embedded care coordinators," nurses who closely monitor the care and progress progress and care of discharged patients to forestall further costly hospital stays. He added that managed care of Medicaid patients would further ensure that services are provided in a coordinated manner.
Expanding and ensuring access, Clairmont emphasized, ensures continuous and preventative care, which enhances the quality of care in the best interest of the patients and reduces the cost of care in the best interest of the hospitals. Lipman pointed out that reducing the cost of serving of the Medicaid population, lessened the pressure to shift costs to those with private health insurance, which raises premiums for employers and individuals in the private market. "Expanding Medicaid is the right thing to do from a public health perspective and an economic perspective," he said.
In 2011, in response to reductions in Medicaid reimbursement rates and a projected operating loss of $4-million, LRGHeathcare closed a dozen primary care offices to some 3,500 Medicaid patients, who were referred to two community health centers and two rural health clinics. Lipman said yesterday that changes in the offing would render the reshuffling of the Medicaid population a thing of the past.