Washington Informer: AmeriHealth Promises Enhanced Care for Residents

AmeriHealth Promises Enhanced Care for Residents

Written by Barrington M. Salmon

Thursday, 09 May 2013 19:06

May 1 marked the first day that AmeriHealth formally took control of the operations of the now-defunct Chartered Health Plan.

On a recent morning, the Northwest offices of AmeriHealth DC buzzed with activity as employees continued to get comfortable with catering to the varied needs of 100,000 of its newest members.

May 1 marked the first day that AmeriHealth formally took control of the operations of the now-defunct Chartered Health Plan (CHP). AmeriHealth officials said they’ve set their sights on ensuring a smooth transition while allaying any fears their new clients might have.

AmeriHealth CEO Michael Rashid echoed the elation he said the staff feels about the transition.

"I’m so excited to be here," he said during a May 1 interview. "What we’ve been doing is transition. We couldn’t be here without the Chartered Health staff. They’re a great staff."

Rashid and several senior staffers said that 150 employees from the Chartered Health Plan were invited to shift over to AmeriHealth.

"We’ve had 30 days to ramp up and during that period, we’ve met with all Chartered doctors and hospitals and 90 percent have agreed to stay with us," Rashid explained. "… It will be a nice marriage. We want to augment what CHP was doing. We’re starting from scratch, turning the page. Huge distractions are off the plate for the employees."

Rashid was referring to the problems that have dogged Charter Health Plan since Jeffrey Thompson, former owner and one of the principals, became embroiled in a federal investigation for alleged campaign finance irregularities. For more than a year, Thompson battled with prosecutors, meanwhile, CHP came under the scrutiny of insurance regulators and city government officials took over the firm and placed it in receivership last October.

Like CHP, AmeriHealth DC will continue to serve low-income residents who’re eligible for Medicaid and other government health programs. AmeriHealth bought the company and inherited Chartered’s 100,000 District residents. AmeriHealth will continue with, and close out CHP’s current contract it has with the city before it commences with its own contract on July 1.

"We’re bringing our 30 years of Medicaid. This is all we do," said Rashid. "We’ll be focusing on understanding the community and Medicare and Medicaid recipients. We’re developing programs geared to the needs of those in the community. We’re trying to connect people to the system."

Rashid said Chartered Health laid a foundation on which AmeriHealth will build.

"Charter is different and it has had relevant programs for is clients. Clients should stay because the future is so bright. We bring best practices and increased resources coming in."

Anne Morrisey, AmeriHealth’s executive vice president and chief operating officer, explained the three top issues the company is focused on.

"We’re making certain that existing members have access to quality care; ensuring that we’re in their communities; and helping them understand the transition," she said. "They’ll have the same benefits and they’ll have the same opportunity to get a similar level of care."

Executive Director Karen Dale said no one’s trying to reinvent the wheel.

"We’re using the care management approach that meets members where they are," she said. "We’ve been working for one and a half years on the total care approach."

That may mean finding out if a diabetic patient has food in his or her refrigerator, checking if they have money for transportation, as well as focusing on and addressing other complex psychosocial issues.

Rashid said AmeriHealth is owned by two Blue Cross plans, which means "patients will be served by Blue Cross which means Cadillac care."

Keeping Chartered Health staff is a non-brainer the executives said, and with the staff on board, continuity continues unabated.

"Clients will be talking to the same people because we’re brought over most of the program," Morrisey said. "We’ve met with them a number of times to bring them on. And we’ve talked to them about the advantages they bring to the marketplace."

She said AmeriHealth is using some Chartered Health staff employed by having them work virtually, assisting staff in other cities.

"The jobs stay here. Obviously, it depends on performance," she said.

Dale said that one of the benefits AmeriHealth brings is a system where everything is integrated.

"We can see families, provide prescriptions and close gaps in care," she said. "Having that integrated system means more and better management."

The executives said a lot of doctors refuse to take Medicaid because the reimbursements are so low and because the onerous paperwork and administrative burden.

"It’s not a D.C. problem, it’s a national problem," said Rashid. "And it’s a rural issue Medicaid numbers are so low. The Affordable Care Act has increased reimbursements. This will attract doctors back."

"Increased prevention will mean an increase in numbers but less doctors."

Dale said the company has worked to reverse the problem.

"We’ve done some things with providers to make it better," she said. "We try to wrap things into one visit and we’ve reduced the administrative burden. We have a provider portal where doctors check eligibility, the status of payments and reduce the time administrative staff would spend on these issues. We have a commitment to providing that level of support."

Dale said AmeriHealth offers doctors incentives to offer extended hours and office hours on weekends.

"If people are going above and beyond, they can get money for that," Dale added.

"The end-game is taking care of clients," Morrisey said. "The capitated rate, incentives and bonuses create a quality health care life for members."

Rashid acknowledged the challenges of providing healthcare to a disadvantaged population.

"We know there are disparities East of the [Anacostia] River. There are higher rates of diabetes, hypertension and childhood asthma," he said. "We plan to leverage our experience and partners, double our teams and dedicate a number of our staff to high-volume pharmacies and practices. Nothing’s changed except the name."

The trio said they plan to leverage their experience, as well as that of their community partners.

"We’ll work with community resource organizations when we need to connect with a part of the community," said Morrisey, a native Washingtonian who was born at the Garfield Hospital in Ward 8. "It’s important to connect to different people who know our membership."

Rashid concurred.

"We’re so big we cannot do it all," he said. "They can reach people we can’t."

He spoke of a church-based program which includes health screenings, information sessions and cooking classes in small settings.

"Then it grows into a thing with 3,000-4,000 women – a health ministry for women," he said. "We have way more power working with community. It can’t happen without the small things we do and build it up."

Rashid said personal contact with clients is the "sweet sauce" of AmeriHealth’s success.

"We try to make it as easy as possible," he said. "We try to do as much as we can to make it easier to serve Medicaid recipients. We’ll call Medicaid recipients, remind them of appointments; we’ll even be in offices to help them explain doctors’ instructions – we’re bringing in resources from outside to improve health care."

"To operate in a vibrant community and only pay insurance claims is not enough. We want people to be healthier, get well and stay well. Building healthy communities, that’s our mission."


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