An Ohio insurer that uses tax dollars to run a Medicaid insurance plan for severely disabled patients is dropping the health network that covers the majority of those patients in Southwest Ohio.
The people in the Buckeye Community Health plan have medical conditions so extreme and expensive, they've been forced onto Medicaid. Some are blind or otherwise severely impaired. Our tax dollars pay to make sure they get care.
Ohio contracts with Buckeye to manage that care. But Buckeye is pulling some of its coverage, and many of the patients have no idea what's about to hit them.
Stephen Kessen is one of those patients. Once a proud worker, a rare blood disorder attacked his heart, liver, kidney and other organs in 2006. He has congestive heart failure, needs surgery and receives constant medical care including blood tests every five days.
Three and a half years of medical bills have left Kessen on Medicaid in a special program for the truly disabled. Ohio taxpayers fund Buckeye to manage Kessen and 3,700 aged, blind and disabled patients in our area.
Kessen comes to Cincinnati’s University Hospital and its clinics for everything, from his general practioner to the many specialists and surgeons and nurses and social workers who track and coordinate his care, and that of thousands of the most desperate patients.
Kessen had no idea until a doctor recently told him that Buckeye was severing ties with the Health Alliance, which owns University and to which all his doctors and medical care workers belong.
He is particularly galled because Buckeye told the Alliance what is was about to do in January, the same month he and the other patients were in open enrollment and able to switch to another Medicaid insurer who is keeping its Alliance contract.
But Buckeye didn’t tell him or the other patients of the impending change until after the enrollment period ended.
Kessen says, "Had I known they were going to dump University Hospital in January, I would have switched to some other provider."
The insurer says it has sent out notifications, but Kessen says he still hasn’t gotten it, one month before coverage cuts off May 1, 2009.
Michele Napier is the Health Alliance's vice president of payor relations. She says the change will come as a rude awakening for some clients, "All of a sudden on May 1, their world changes. Their doctors change, and that is a huge issue."
Napier says the Alliance, as one of the largest collections of hospitals, clinics, doctors and other caregivers across the Tri-State, has spent years putting in place an interwoven network of care on which thousands of patients depend. It keeps track to give patients a seamless medical service, to remind them of appointments and offer more referrals in a convenient one-stop-shopping medical community.
Napier calls what Buckeye has done "absolutely wrong. We feel that this is absolutely unfair” to patients.
Dr. Eric Warm, the medical director of an Alliance clinic at University Hospital is outraged his patients will lose coverage. “This is absolutely awful," he says. "I think it's kind of a dirty trick to get the enrollment period through and then throw this at them."
Dr. Warm says even though Buckeye gets a premium above Medicaid rates to care for the patients, it wanted to pay the Alliance less than Medicaid rates, which on their own are so low many doctors and moreso, specialists, won't accept them. That will leave patients scrambling for care from multiple doctors. He worries they won’t find certain specialists at all.
Kessen says switching so many doctors in the middle of his complex treatment plan “would be devastating. To have to go to another hospital or doctors’ group to start all over from scratch, it's crazy."
Kessen says he chose Buckeye over another similar Medicaid provider simply for its name. "I only took Buckeye because it was BUCKEYE, and I'm an Ohioan."
But Buckeye really is owned by
Centene Corporation, based in St. Louis, a corporation in the midst of a $27 million expansion, whose latest annual report shows it more than doubled its earnings from operations from 2007 to 2008.
We asked the insurer for an interview, which its senior director of corporate communications, Sandy McBride, declined. She sent a statement which said Buckeye was disappointed it couldn’t continue to work with the Health Alliance but “We have successfully established relationships with every other major hospital system in the Greater Cincinnati area. As a result of the strong network of health providers we have in place, the people we serve in Cincinnati will continue to have access to quality healthcare services.”
But Dr. Warm says Buckeye is missing the point. It’s the seamless integration of services that this patient population needs. Napier says the Alliance keeps track of these patients and their appointments to make sure they don’t fall through the cracks. Patients who must leave the Alliance will have to piece together their many medical needs with no one coordinating their care, something the disabled and blind may need even more than most patients.
Dr. Warm doesn’t mince his words: "This is just another example of when you put profit and health care in the same sentence, bad things happen to the most vulnerable population,” he says. “It's a moral issue because what's happening is that this company is taking the care of these patients and jeopardizing it for profit."
And Kessen says he feels Buckeye and Centene aren’t taking into account that he and the others already are overwhelmed by their medical conditions. The last thing they need is disruption in service, he says.
"It's just more than a numbers game,” Kessen says. “These are real people with real problems. The idea of you trying to make money on the backs of the blind, disabled and the indigent, shame on you. Look at AIG. That's an outcry. This should be an outcry on the same level."
Because Kessen found out from his doctor about the change, he called Buckeye and the state Department of Jobs and Family Services. He says operators at both told him he was stuck because the enrollment period had ended.
But that’s not true. Patients who want to keep their current health care can call ODJFS until April 30 and ask for a "waiver for just cause." The state will then determine if they can switch from the contract they just signed with Buckeye in January to another Medicaid provider, keeping the Alliance and its doctors.
Kessen called the number,
1-800-605-3040, and has requested a waiver.
McBride says Centene is addressing this issue, “In light of your description of that particular member’s experience, we are reiterating with all of our customer service personnel in Ohio how they are to address and help members who may be affected by this transition.”
You can read the rest of the insurer's statement linked here.
