The state Department of Health and Human Resources is tabling aplan to reorganize the state's Medicaid program.
Agency officials want to give themselves and lawmakers, who hadbeen critical of the changes, more time to study the issue.
The state currently has contracts with three firms - The HealthPlan of the Upper Ohio Valley, Unicare and Carelink - to providebasic health care to more than 160,000 Medicaid recipients whoreceive government-sponsored health insurance because they are onwelfare.
Managed care companies are firms that provide health carebenefits while at the same time controlling costs through means suchas providing monetary incentives for physicians and patients to pickless costly forms of care, reviewing the medical necessity oftreatments and controlling inpatient admissions and lengths of stay.
Such firms are often referred to as health maintenanceorganizations or preferred provider organizations.
By entering into agreements with these companies, the statecontrols its costs by paying the companies a lump sum each year.That essentially shields the state from unexpected expenses byforcing the companies to assume responsibility for controllingcosts.
Beginning next year, the department had planned to integrate bothbehavioral and dental care for the poor under the umbrella of thosemanaged care companies.
In addition, the state's more than 55,000 recipients ofSupplemental Security Income - which provides assistance toindividuals who are blind, disabled or have serious mental disorders- would have been added to the managed care system.
Lawmakers have criticized the plan mainly because competitivebids were not sought. The managed care companies stood to receive anestimated $270 million boost in business.
Critics also expressed concerns that the plans could result in aloss of access to critical health services for disabled or mentallychallenged residents in need of behavioral care services.
DHHR Secretary Michael Lewis, who was appointed to the post lastmonth by acting Gov. Earl Ray Tomblin, issued a statement lateSunday saying the plan would be put on hold to allow further review.
Lewis cited the need for a successful integration of patientcare, as well as the recently passed federal health care overhaul,as reasons for further study.
'As a primary care physician who has been trying to keep peoplehealthy for more than 30 years, I realize how important it is toprovide to our clients the right service at the right time by theright provider,' Lewis said in the statement.
'I am today instructing the Bureau for Medical Services tocontinue to work with managed care companies to build the neededpanels to successfully provide the integrated care our clients needto get them healthy and keep them healthy.'
The panels are the doctors and service providers who would offerservices to the Medicaid patients.
'Sometime after the 2011 legislative session, when we have abetter idea of the status of national health care reform, we willevaluate where we are and determine how best to proceed to serve theneed of our clients,' Lewis said.
Lawmakers welcomed that move, saying it will give them more timeto provide input on how the state goes about spending $600 millionon Medicaid benefits.
'I applaud the new secretary for taking a little more cautiousapproach and trying to get more information to the table than whatwe've seen so far,' said Delegate Don Perdue, D-Wayne, who chairsthe House Committee on Health and Human Resources.
'This will give us time to see what the proponents are, and whatthe ups and down are, and make the right decision.'
Delegate Nancy Peoples Guthrie, D-Kanawha, was a critic of theDHHR's plan to implement the managed-care expansion without seekingbids.
Agency officials had said regulations did not require them toseek bids for Medicaid contracts as providers are paid using setreimbursement tables.
Guthrie introduced legislation last year to require the agency toseek bids, but it was vetoed by then-Gov. Joe Manchin.
'Nobody questions the right they have to do it. The question is,is it sensible,' Guthrie said.
She hopes the delay will offer more time to determine whethermoney is being spent as efficiently as possible.
'The question is whether or not the legislature, along with thehelp of Dr. Lewis, is going to take a more focused view of how we'regoing to spend this money, where we're going to spend this money andwith whom.'
Both Guthrie and Perdue said the department should look at waysof making sure the managed care firms, which may have support stafflocated out of state, are employing as many people locally aspossible.
They said if the money is going to be spent by the state, itshould be used as much as possible to boost employment within stateborders.
'I think we've got to the point where we need to look closely asto whether we can do that ourselves,' Perdue said. 'It may bedetermined that we just can't do that, but it's never been tried.'
Guthrie said Lewis, who has previously served as vice chancellorfor health sciences at the state Higher Education Policy Commission,has more of a background in medical economics than prior DHHRsecretaries and could offer more insight into potential employmentopportunities.
'I'm hopeful that Dr. Lewis, because of his background, will atleast give us the opportunity to sit down with him and discuss maybebetter ways of managing these contracts so that we keep more of themoney in the state, create more jobs here, and provide betterservice,' she said.
'I would like to have a clearer demarcation of who's operatingthese programs, where are they operating from and where are the jobsbeing done.'
Guthrie also hopes a review process will determine how muchrevenue would go to administrative costs rather than patient care.
'Are we spending 20 percent of these contracts on administrativeoverhead, or is it more in the range of 5 percent?' she said. 'Howmuch are we getting for our money, and how much are they getting fortheir money?'
Tom Susman, a lobbyist with the West Virginia Behavioral HealthCare Providers Association, also was critical of the prior process,saying it focused more on the managed care companies rather thancreating a network of individual local doctors who would ultimatelyprovide patient care.
'We were more worried about taking care of the HMOs and not theintegration,' Susman said. 'Dr. Lewis clearly understands primarycare, and I think it's very positive that he's willing to takeanother look at it.'
Susman said he didn't believe the three contracted managed careproviders were guaranteed the business under the new integratedsystem.
'Integrated care does not equal HMOs,' Susman said, 'and webelieve that we can integrate physical and behavioral and sub-specialty care on a provider-by-provider level and not throughHMOs.'
Susman, Guthrie and Perdue all agreed the state could benefitfrom looking at other systems around the country in the comingmonths.
'One thing I've come to learn from my years in the legislatureis, the more deliberate it is, generally the better it is,' Perduesaid. 'I'm just appreciative of the department taking a longer, moredeliberate look at this.'
Contact writer Jared Hunt at jared.hunt@dailymail.com or 304-348-5148.
