Hopkins forms Medicaid group 11 health centers join organization that provides managed care

November 20, 1996|By M. William Salganik | M. William Salganik,SUN STAFF

A network of 11 community health centers across the state will be a 50-50 partner with Johns Hopkins in a new managed care organization created to enroll Medicaid patients, the parties announced yesterday.

The new organization, to be called Priority Partners, expects to enroll 30,000 to 35,000 members during the first year, said Jerome H. Gotthainer, chief operating officer of Johns Hopkins HealthCare.

During a six-month period beginning in February, the state will move about 300,000 Medicaid patients -- mostly welfare mothers and children and some categories of disabled people -- into managed care plans. Existing HMOs can enroll patients, but new managed care organizations can also form to provide HMO-like services.

About 100,000 Medicaid patients already are in HMOs, but they also will be able to choose another plan if they want.

Hopkins had already said it would be forming a managed care organization with community health clinics, but yesterday's news conference provided additional details about the new entity.

The clinics, which previously worked together in a trade organization, formed themselves into Maryland Community Health Systems Inc. in June to prepare for the Medicaid switch. Patricia Cassatt, executive director of the People's Community Health Center in Baltimore, serves as president of the group.

The centers could have contracted with HMOs to treat patients rather than forming their own managed care organization, but "being an MCO or being part of an MCO gives us a voice in how we care for patients," said Karla R. Roskos, executive director of Greater Baden Medical Services, which operates three clinics in Prince George's County and Southern Maryland.

"Whatever excess there is of revenue over expenses, we're going to feed that back into patient care," said Roskos, who is also secretary-treasurer of Maryland Community Health Systems. "We don't have to answer to stockholders."

The group considered forming a managed care group, she said, but decided it needed a partner because "to form a management services organization on our own in a short period of time would have been a Herculean task."

Hopkins will handle management tasks such as enrollment and claims processing. It already has a structure to do this for its employee health plans, which provide medical care to employees of self-insured companies.

For Hopkins, the clinics bring a patient base, helping assure that Hopkins does not lose Medicaid patients as a result of the shift to managed care. Medicaid provides about a fifth of Hopkins' patients.

Medicaid patients who enroll in Priority Partners can select primary-care physicians at one of the participating health centers or on the Hopkins campus or at its Hopkins Bayview Medical Center. They can also receive care from doctors in the community who have contracts with Johns Hopkins HealthCare.

Preferred Partners will reach from Western Maryland to the Eastern Shore. Only two rural counties, Cecil and Garrett, do not meet a state guideline of having a clinic or provider within 30 miles or a 30-minute drive, Roskos said.

Participating clinics in Baltimore, which has the largest share of Medicaid recipients in the state, are Baltimore Health Systems, Chase Brexton Clinic, Glenwood Health Center, Jai Medical Center and People's Community Health Center. (Some have additional locations outside the city.)

Also participating are Caroline Health Services, Eastern Shore; Community Clinics, Montgomery and Prince George's counties; Greater Baden; Owensville Primary Care, Anne Arundel County;

Three Lower Counties Community Services, Eastern Shore; and Tri-State Community Health Center, Western Maryland. All except Jai are nonprofit.

Pub Date: 11/20/96

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