Helix Sets Up Organization For Medicaid

Unit Will Function As Hmo For Patients On Medical Assistance

`Control Of Your Destiny'

Such Managed Care Called By Some A Step To Employer Contracts

April 29, 1997|By M. William Salganik | M. William Salganik,SUN STAFF

Helix Health announced yesterday that it will launch a Medicaid managed-care organization called Helix Family Choice, essentially functioning as an HMO for medical assistance patients.

The five Helix hospitals get about 15 percent of their inpatient admissions from Medicaid patients, "and we don't think you're going to get [those patients] for the future if you're just a provider," said James A. Oakey, Helix president and chief executive officer.

By setting up an organization to enroll patients, rather than just caring for those enrolled in other HMOs, Oakey said, "what it talks about is control of your own destiny."

Some in the hospital industry see the Medicaid managed-care organizations as preliminary steps toward hospitals contracting with employers and other payers, cutting out HMOs and other insurers. However, Oakey said Helix has no interest at this time in contracting directly with Medicare or for commercial patients.

Helix, like several other hospital systems, qualified this month to be a managed-care organization under Maryland's reform of its Medicaid program. The state will require 330,000 Medicaid recipients, mostly mothers on welfare and their children, to enroll in managed-care programs beginning in June.

The state will pay each managed-care organization a flat rate per member per month, and the organization is responsible for providing all care, from physician visits to hospital admissions.

Two other hospital-based managed-care groups have been approved by the state: Priority Partners, which comprises the Johns Hopkins system and 11 community health centers; and Maryland Physicians Care, made up of Maryland General Hospital and three hospitals in Western Maryland. New American Health, based at North Arundel Hospital, has an application pending.

Three HMOs that have been caring for Medicaid patients -- FreeState, Prudential and United (formerly Chesapeake) -- have managed-care certification. Two other HMOs, Prime Health and the George Washington University Health Plan, have applied.

Barbara Shipnuck, deputy secretary of health and mental hygiene, said the state wanted to encourage a variety of health networks to enroll Medicaid patients because "we felt our recipients had the right to make the choice for themselves as to the type of provider the want."

She said she had been "very pleased" to receive applications from "a combination of traditional HMOs and the new type of system we thought we'd see."

Calvin Pierson, president of the Maryland Hospital Association, has led an unsuccessful effort for two years to pass legislation giving hospitals and physician groups the right to create HMO-like "community health networks."

"The Medicaid MCO is a first demonstration of how direct contracting by a community health network or integrated health system can be effective," he said.

HMOs fought legislation that would have made it easier for hospital-based networks to contract directly with employers, but they have not objected to the hospitals competing with them to enroll Medicaid patients.

"We view them as competition, but competition keeps us honest," said Elizabeth Misek, chief executive officer of Prudential HealthCare of the Mid-Atlantic. "It will be a challenge for all the MCOs to survive and thrive, given the amount of Medicaid business."

The Helix organization will basically attempt to serve the areas around the five Helix hospitals -- Franklin Square in White Marsh and Church, Harbor, Good Samaritan and Union Memorial in Baltimore, said Harrison J. Rider III, Helix chief operating officer.

He said about 250 community physicians -- about half in the HelixCare physician group and the rest contracting with Helix -- would provide primary care. Participating doctors, some of whom will also be contracting with other managed-care organizations, are not required to send their patients to Helix hospitals, Rider said.

Pub Date: 4/29/97

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