Health cabinet needs to step up enforcement to salvage managed care, Auditor Adam Edelen says

05/04/2012 01:09 PM

The state’s Health and Family Services Cabinet must apply “new aggressive leadership” to salvage its managed care set-up, state Auditor Adam Edelen said.

Edelen, whose interview about the managed care system aired on Thursday’s edition of Pure Politics, said the managed care approach is the right one to save the state money in the Medicaid program that covers care for the poor and disabled. But he said new cabinet Secretary Audrey Haynes faces a tough task to smooth out the rough edges.

Appalachian Regional Healthcare, which serves more than 25,000 Medicaid patients, had threatened to end its dealings with the managed care organization Coventry because of the troubles the hospital network has had with it since November. Joe Grossman, Appalachian Regional Healthcare’s chief financial officer, told lawmakers in February that he felt “like a bank” for the managed care organizations because they weren’t paying medical bills for Medicaid patients on time.

Coventry and Appalachian Regional Healthcare came to an agreement Friday afternoon.

“If our largest Medicaid provider in the part of the state that needs it most for some reason isn’t able to operate within this system because they can’t manage their relationship with Coventry or vice versa, that represents a structural threat to the system,” Edelen said (1:20).

He said the “excellent” contract with the managed care organizations is strong but the cabinet must be more aggressive in enforcing the provisions. (3:40)

“This is going to be one in which the cabinet has got to be willing to wield the stick,” Edelen said (2:00).


Subscribe to email updates.

Subscribe and get the latest political intelligence delivered to your inbox.