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HMO offers Medicaid patients easier access to care, saves state money HOWARD COUNTY HEALTH


Jewell Ortiz of Savage is relieved that Columbia Medical Plan is enrolling Medicaid recipients as members. Now she doesn't have to search for doctors who accept Medicaid patients.

Before Barbara Jackson joined the health maintenance organization, she and her 2-year-old son visited different doctors on opposite ends of Columbia. Now the Long Reach woman and her son travel to the same location for doctor appointments. "Everything's right there," she said.

Both women are among nearly 600 Howard County Medicaid recipients who have become full members of the managed health care plan.

In April, Columbia Medical Plan became the first HMO outside of Baltimore to enroll Medicaid patients as members under a $1.2 million contract with the Maryland Department of Health and Mental Hygiene.

So far, the HMO has accepted about 1,000 Medicaid patients from Howard, Anne Arundel, Carroll and Frederick counties.

Columbia Medical Plan and state health officials say the new contract will save the state thousands of dollars a year while offering area Medicaid patients a variety of services they never enjoyed before.

"They have access to this breadth of care that they didn't have before," said Lorraine Tunis, Medicaid marketing manager for Columbia Medical Plan.

The HMO program is voluntary. Medicaid patients who are not HMO members can visit Columbia Medical Plan on a fee-for-service basis, in which the state reimburses health care providers for each service they offer.

Medicaid recipients can also enroll in the Maryland Access to Care (MAC) program, which requires them to select a primary care provider for basic care but allows them to choose other physicians for specialized care, such as obstetrics and gynecology.

As full HMO members, Medicaid patients have access to all physicians who work with Columbia Medical Plan.

"Everything's right there in the same building," Ms. Jackson said. "For prescriptions, it's right across the hall."

In addition to Medicaid benefits, HMO patients also receive adult dental and vision care, which the state eliminated last year.

That means a lot to Ms. Ortiz. She has worn glasses for the past 15 years and feared that she wouldn't be unable to afford them without medical assistance.

The state is saving about $50,000 to $60,000 a year under the Columbia Medical Plan contract, said Katherine Tvaronas, staff specialist for the state health department's HMO Program.

The state could save about $250,000 each year once Columbia Medical Plan enrolls 5,000 Medicaid patients, she said.

The state is able to save so much because it pre-pays Columbia Medical Plan for all services. Instead of reimbursing the HMO for each service it performs, the state pays about $107 for each Medicaid patient each month.

"The state saves 4.5 percent of what it would spend on the fee-for-service basis," Ms. Tvaronas said.

But unlike the fee-for-service and MAC programs which allow patients to choose their own doctors, the HMO program requires patients to see only those physicians who contract with Columbia Medical Plan.

"The services in the HMO are managed to a much greater degree," Ms. Tvaronas said.

But the lack of choice does not seem to bother the new HMO members.

"It's good to have one doctor that knows your whole medical history," Ms. Ortiz said. "He knows what grades my kids are going in."

The HMO has been accepting nearly 60 Medicaid patients a week throughout the region, Ms. Tunis said. "By the end of next year, we should have 5,000 people."

To handle the increase in new members, the HMO has hired two new sales people and two patient service representatives. Four more employees in those fields will be hired next month, Ms. Tunis said.

The most frequent complaints from Medicaid patients is having to wait an hour or more to see a doctor and not receiving the services they were promised by the HMO sales force.

"They've had a problem accessing services this way and they have a desire to return to their old provider," said Larry Triplett, director of the state's Medical Care Compliance Administration.

The state contracts with three Baltimore City HMOs: Prudential Health Care Plan, Chesapeake Health Plan, Inc., and Total Health Care.

At Columbia Medical Plan, Ms. Tunis said employees are conducting follow-up interviews with new HMO members to ensure that they understand what services are included under the program.

"A case worker will call every member to review what it means to be an HMO member," Ms. Tunis said. "There's a second attempt at education."

Columbia Medical Plan is also attempting to speed up service by assigning employees to answer phones exclusively (thus freeing up others to help waiting patients), advising people to call in for appointments when it's not busy, and awarding $5 vouchers to those who wait more than 20 minutes to see their doctors. The vouchers can be used to buy such items as prescription medicine.

Although the state health department has contracted with the three Baltimore HMOs since 1976, suburban HMOs have been reluctant to enroll Medicaid recipients as members because of reimbursement differences in jurisdictions, fewer organizations willing to treat the poor and fewer Medicaid patients.

"It's difficult for an HMO to start up in a rural area," Mr. Triplett said. "It's riskier."

Despite the risks, some health care experts predict that managed health care systems will continue to enroll more Medicaid recipients.

"It will provide a greater range of services to a greater number of patients for a lesser cost," Ms. Tvaronas said.

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