Mark Carter

(Editor’s Note: Mark Carter, now the interim CEO of Passport, has blogged occasionally for Insider Louisville about healthcare issues. At the time, Carter was Louisville office manager for Dean Dorton Ford, a Lexington-based accounting and consulting firm. Since then, Dean Dorton Ford has merged with Cotton+Allen, a Louisville-based accounting firm, to create Dean Dorton Allen Ford.)

Though we didn’t know it was in the works, Mark Carter was appointed today as Passport Health Plan interim CEO. Carter replaces Dr. Larry Cook, who had announced his resignation.

Earlier today, Gov. Steve Beshear told Passport officials to overhaul the organization or the provider-funded (the providers being Louisville’s hospital systems) health plan would lose its contract with the state.

Mark’s interim appointment makes complete sense to us at Insider Louisville. He’s simply the best available person.

We know Mark as possibly the most capable insider in Kentucky’s healthcare industry, having been CFO of Jewish Hospital & St. Mary’s Healthcare Inc. before joining Lexington-based accounting firm Dean Dorton Ford – now Dean Dorton Allen Ford.

What we’ve always found refreshing about Mark is that he’s as respected and influential as any insider, yet somehow remains grounded, low-key and candid. He’s the only “smartest guy in the room” we’ve ever met who never makes a show of his intellect and his instant grasp of crucial details.

He’ll need all those traits and talents and more.

Mark takes over a troubled program that he above all people knows could be come a political football.

On November 10, Crit Luellan, Kentucky state auditor, issued a report recommending radical changes at Passport. Luellen’s report found a staff spending freely tax payers’ money on lavish travel and entertainment. They were paid well to oversee a public trust – a plan administering Medicaid funds for 160,000 poor people in Jefferson County and 15 other Kentucky counties.

Mark’s a superb choice to turn around Passport because he’s already intimately involved in myriad efforts to improve and streamline healthcare in the state. He’s touched endless deals from the recent merger of Jewish Hospital, the University of Louisville’s medical operations and Denver-based Community Health Initiative Inc. to his accounting and consulting work.

On September 26, Mark blogged about the resignation of Betsy Johnson as Medicaid Commissioner the week before. We’re including some out-takes from that column, points that may prove to be insights into his approach at Passport and to his take on what lies ahead:

Predictably, the reporting dwelt on the politics of it all; snarky quotes from legislative leaders and a defensive response from the administration pointing the finger back at the legislature.

The truth is, they are both right.

Much like what has happened to the state retirement system, recent administrations have not addressed the fundamental issues surrounding Medicaid. The legislature has only prolonged the agony by refusing to address looming shortfalls with new funding, innovative approaches, or by downsizing the program.

There is a half-billion dollar hole in the program that gets worse as health care reform adds to the program rolls.

The various sectors of the industry (hospitals, nursing homes, pharmaceutical manufacturers, etc.) are notorious for pursuing their own self-interest with little regard for the overall operation of the program.

There’s a looming gubernatorial election that will poison any public policy development through November 2011.

A legislative task force studies the issue (and studies and studies and studies…you get the picture).

And, the administration, for whatever reason, hasn’t put forth its plan for addressing daunting problems with Medicaid.

So there stood Betsy Johnson in the proverbial doorway to a Who concert with festival seating; bearing the brunt of legislative ire toward the administration while unable to articulate a cogent response to the problem. She most certainly surveyed the scene and pondered her professional future. It’s not really surprising that she chose to pursue a career as a health care lawyer.

More troubling is the fact that anyone with any ambition would have remained in the post if a workable solution had been at hand.

It doesn’t take much imagination to see that one’s professional standing would have increased substantially after presiding over the successful reform of the Medicaid program.

In my opinion, Commissioner Johnson’s resignation should be a clarion call for all of us…the Medicaid program, and the Commonwealth’s budget, are in dire straights.

But, solutions do exist. They are simply difficult to adopt politically and to implement from a policy standpoint.

In my view, two things need to happen before this problem can be solved:

  • First, we the people need to come to grips with the moral imperative surrounding the Medicaid program. It’s a program that cares for poor people. And, we as a society have an obligation to care for the poor. The most rational way to approach the problem is on a statewide basis through the instrumentality of the Commonwealth of Kentucky and our Medicaid program.
  • Second, and perhaps a radical departure for me, is that we have to acknowledge that there is a finite amount of money that can be spent to meet that moral obligation. When designing a solution, we have to consider the constraints that exist. One that is clear is that we have fiscal constraints.

We spend a tremendous amount of money on acute manifestations of chronic diseases (diabetes, obesity, heart disease and on and on), but virtually nothing on prevention and health and wellness. So, for all of the money spent, we get very little in return.

Money for nothing.

Yet, we have a highly successful, nationally recognized, Medicaid managed care plan here in Louisville (Passport Health Plan) that does focus its spending on prevention and care and disease management. This approach needs to be considered by our public policy apparatus.

In other words, maybe we need to look at how we are spending the money we have, instead of throwing good money after bad. Yet, Passport finds itself between the proverbial rock and hard place. It appears the political infighting — both within and between political parties and branches of government – are combining to prevent a sober analysis of managed care as an alternative to the failing approach utilized throughout the rest of the Commonwealth.