Brian Tucker, you better sit down for this one, hoss.
I never thought I’d write a paean to a right-wing radio host, but thank God for Mandy Connell.
Yesterday, after the WHAS 84 morning talk show host received a copy of St. Louis-based Centene Corp.’s lawsuit against the Commonwealth of Kentucky, Connell dedicated about 25 minutes of airtime to parsing what we at IL like to call Kentucky’s Medicaid Meltdown.
(Centene operates in Kentucky as “Kentucky Spirit.”)
We also got a copy of the Centene suit, and it’s likely IL shares some sources with Connell. But candidly, we didn’t immediately appreciate the suit’s potential to derail Gov. Steve Beshear’s political career.
Mandy Connell did.
(You can hear the Centene segment here, which starts at the 9:30 mark.)
So, on the fly, she was reading the 30-page complaint while her producers set up a long, meaty interview with State Rep. Julie Denton, a Louisville Republican who has been in committee meetings as the meltdown has gone from comical to critical.
Before we go any farther, I don’t agree with much the woman who once called President Obama “a half-breed” believes politically. Also, praising Connell doesn’t benefit IL. When our Mark Coomes was on her show to talk about his “Judge Not” investigative stories, we got zero in the way of a traffic bump because our audiences have zero overlap.
But I have to say Connell isn’t afraid to work hard to tackle complex, important topics in the public interest, unlike most journalists in town, with thoughtful analysis and reporting.
Where our common interests intersect is the non-partisan conclusion that Kentucky, a poor state, suffers from chronically poor governance.
Centene is suing the state, charging officials with the Cabinet for Health and Family Services, Kentucky’s Finance Cabinet and the Kentucky Department of Medicaid Services gave Centene faulty data as it was putting together its bid last year for Medicaid managed care contracts.
Centene executives allege doctored data on the overall health of Kentucky’s Medicaid members, and major contractual omissions led the insurer to lose $120 million since the contracts began last November, millions it wants back.
It’s funny how pedestrian scandals have sunk Kentucky governors – Gov. Paul Patton’s 2002 peccadilloes are an example – scandals that had no impact on ordinary citizens. Yet the Beshear Administration is in the middle of a crisis that could lead to the state losing hundreds of millions of dollars, a story that’s gotten zero traction with the Courier-Journal.
One Great Newspaper mentioned yesterday’s Centene developments with 13 confusing paragraphs.
By comparison, Connell got after it.
She explained the genesis of the Beshear Administration’s switch to Medicaid managed care from fee-for-services – not the sexiest of subjects – and how we got to where we are today.
Then she got to the good stuff:
Connell pointed out that Centene’s attorney is none other than Betsy Johnson, Beshear’s former Medicaid commissioner. “Talk about someone who knows where the bodies are buried!” Connell said.
She also noted that Johnson works at Stites & Harbison, Beshear’s former law firm where Beshear’s son still works, and where the governor is lionized. This abandonment of allegiance Connell rightly interprets as how tenuous Beshear’s political position is, and fleeting his influence.
What Connell failed to note is all the other MCO machinations including multiple suits, interruptions of patient care, whole hospital groups ejected from the Medicaid network and other vicious machinations Beshear’s-ill considered, rushed switch has caused.
Though she did say, “If I tried to make up a story of incompetence, I don’t think I could make up a better one than this story of the … governor and Medicaid managed care.”
Ultimately, Connell’s nonpartisan conclusion is one with which we totally concur: Beshear had Passport Health Plan already managing a huge percentage of Kentucky’s Mediciad managed care population and doing what everyone agrees is an efficient, effective job.
“It wasn’t like we had to reinvent the wheel,” she said. “We already had managed care …. but guess what. We couldn’t just expand that, as has been done in other states ….”
Instead, Beshear rushed through Medicaid reform so he could claim “savings” in his gubernatorial race last year against State Senate President David Williamson, she noted. A cunning tactic against a long-time foe.
Clearly, Connell is a partisan Republican, and excoriating a suddenly vulnerable Democratic governor likely boosts her Tea Party listenership. But as Connell noted, she used her influence to try and push out an incompetent Republic governor in Florida.
I have to say Denton and Connell worked through this Gordian knot very systematically.
Instead of Kentucky saving $370 million, which was Beshear’s justification for wreaking all this chaos, Kentucky is facing years of legal wrangling with a fairly large publicly traded company, which can afford capable and aggressive legal counsel.
At the least, Kentucky has to start all over with Medicaid.
At the worst, we could do so facing the prospect of having to pay Centene a 9-figure settlement.
I’m sure Mandy Connell will come after Insider Louisville one day, and I’ll change my tune.
But for the moment, I am thankful someone in Louisville is covering this mess beside Insider Louisville.
The back story on Kentucky’s Medicaid Managed Care Meltdown:
In April 2011, state officials asked health insurers to submit managed-care proposals for the $6 billion worth of care 800,000 poor and elderly Kentuckians receive annually under the federal/state Medicaid program. At the time, Gov. Steve Beshear touted the switch to managed care from fee-for-services as saving the state $375 million over the life of the initial three-year contracts. Insiders said officials in other states such as Georgia took as long as 18 months to make the change while Kentucky tried to do it in less than six months.
The three companies receiving MCO contracts were Centene, WellCare and Coventry Cares, all publicly traded companies. (Passport Health Plan, a Louisville-based non-profit controlled by providers, is the managed care insurer for Jefferson County and 17 surrounding counties.)
Each bid for the Kentucky MCO business was based on per-member, per-month health care costs projections. Low-bidder Centene bid $330 per member, per month, according to documents submitted to Insider Louisville. WellCare bid was based on $400 per member per month, and Coventry bid $436 per member per month.
The algorithm state officials used to choose the winners favored the low-cost plans, obviously, because therein lies the savings.
The state methodology initially assigned members to a plan, with the two lowest cost plans getting more members than the highest.
If Centene’s manged care system actually got each member to spend less than $330 per month, they’d make a profit. But crucial to getting costs that low would mean cutting reimbursements to health care providers such as doctors and pharmacies, which meant losing some.