Medical providers fear Passport insolvency would disrupt patient care


An insolvency of Passport Health Plan would disrupt care for Medicaid beneficiaries and likely would force more doctors to stop accepting Medicaid patients, local health experts said.

For some patients, especially those with mental health problems, even short interruptions of care can cause devastating effects, the experts told Insider. And if the managed care organizations that would replace Passport pay health care providers even less, some of them may just decline to provide services for Medicaid patients altogether. And that, too, could lead to interruption of care, as patients who often don’t have access to reliable transportation have to travel further to find doctors willing to address their health problems.

“I am concerned about what’s going to happen to the beneficiaries,” said Dr. Wayne Tuckson, a colon and rectal surgeon and president of the Greater Louisville Medical Society.

Dr. Wayne Tuckson

Tuckson told Insider that he believes Passport understands the community and its needs very well and has served as a “very good partner” to local medical providers who are taking care of people who often struggle to get care.

Passport is one of five organizations in Kentucky that manage Medicaid benefits. Medicaid is a mostly federally funded health insurance program primarily for the poor, pregnant women and people with disabilities.

The state last summer changed the way that it distributes Medicaid dollars, and Passport officials have said that the new rates threaten the nonprofit’s solvency. State officials have told Insider that they changed the distribution rates because of budget cuts and to bring profitability of Kentucky’s managed care organizations in line with the national average.

Passport is suing the state to have previous rates reinstated. Unrelated to the dispute, the state has proposed new distribution rates that are to take effect April 1. Passport told Insider Friday that the rates are higher than expected, but could not yet say whether they would be enough to avert the nonprofit’s insolvency.

Passport manages Medicaid benefits for about 312,000 Kentuckians, about two-thirds of whom live in the Louisville area. If Passport became insolvent, the Medicaid beneficiaries would have to find a new managed care organization and, depending on that organization’s network of medical providers, may have to switch to a new doctor, therapist and hospital.

Tuckson told Insider that he worries that if Passport failed, the beneficiaries would struggle to find new providers and suffer interruptions in care. Some of the beneficiaries may find out that the physician whom they’ve visited for decades does not have a contract with the new managed care organization. That would require patients to find a new doctor, and if that doctor’s office is two bus transfers away, they may have a tough time getting there, Tuckson said.

Health experts have told Insider that some of those additional difficulties could mean patients don’t see doctors for what they think may be minor medical conditions that, untreated, can turn into serious health problems, the treatment of which may cost more down the line because it is provided in emergency rooms — if at all.

Mental health challenges

Ramona Johnson

Such a downward spiral can be especially insidious for people with mental health challenges, said Ramona Johnson, president and CEO of Louisville-based Bridgehaven, a nonprofit that provides rehabilitation and recovery services, education, and support for people with mental illnesses.

Bridgehaven offers services up to six days a week for more than 500 patients annually.

The nonprofit, at 950 S. First St., helps people with persistent, lifetime disorders understand and take control of their illness to enable them to live lives to the best of their ability. Johnson said that can mean learning basic living or conflict resolution skills or taking part in cognitive enhancement therapy, a yearlong, once-a-week program that helps people with mental illness, especially schizophrenia, overcome negative symptoms.

Johnson said that while medications may treat symptoms such as hallucinations or hearing voices, they do not address challenges related to social isolation. CET helps the patients with some of the challenges that make it difficult for them to go to school or work, such as interacting with others.

Many of the patients have been managed by Passport for years, Johnson said, and many of them struggle with change. If they lose Passport, they probably would worry about how they can find a new managed care organization, whether that MCO would be as supportive as Passport has been and whether their mental health provider is part of the new MCO’s network.

“I think that creates anxiety,” Johnson said.

Antionette Spalding

Antionette Spalding, 31, of Louisville, said she recently learned about Passport’s fiscal problems and wonders whether they will affect the services she is receiving.

“I’m just confused with the whole situation,” she told Insider recently in an office at Bridgehaven.

Spalding works for her brother’s hair products distribution business, working at a computer and preparing boxes for shipment or breaking them down for recycling.

She qualifies for Medicaid because the money she earns is not enough to pay for pills she takes for high blood pressure, insulin injections she takes twice a day for diabetes and her medications to treat her bipolar disorder, which started when she was 7 years old.

Spalding has attended programs at Bridgehaven for about two years, coming three times a week from 9 a.m. to 3 p.m.

Spalding said that before coming to Bridgehaven, she also suffered from depression, lived with relatives and stayed at home all the time. Now, she said, she lives by herself, is a lot happier and has lost 56 pounds.

Peer Support Specialist Tara Bassett said Spalding has made enormous strides since she came to Bridgehaven.

“We’re really proud of her,” she said.

Severe mental disorders lower a patient’s life expectancy by 10 to 25 years, in part because mental illnesses affect physical health, according to the World Health Organization. Bassett said Bridgehaven’s approach to supporting patients combines mental and physical health and includes weight and blood sugar monitoring, advice from a registered dietician, healthy foods prepared in the kitchen and exercise at the YMCA.

Spalding “is doing everything she can right now to get herself healthy.”

That’s in part because Passport is supposed to help her with weight loss surgery, and Spalding wonders whether she will get the same help if Passport goes away.

She said she also worries about losing her doctor, with whom she has dealt for about a decade, since her diabetes diagnosis.

“I would be devastated,” Spalding said. “I don’t want to lose her as my doctor.”

Johnson said that changing medical providers is especially difficult for people with mental illnesses because they have to tell their often difficult stories to a new set of medical providers. For some, the challenge can be so daunting that they forego treatments. And once that happens, the problems that previously were under control can quickly become unmanageable. That means the patients end up in emergency rooms because of untreated illnesses or they fall prey to violence or are arrested and put in jail for minor offenses, Johnson said. Those dynamics can quickly derail the patients’ lives and result in them being estranged from loved ones, losing their jobs and their homes.

“Nobody wants that to happen,” she said.

Provider impact

If Bridgehaven’s services aren’t covered by the new MCO, patients may lose access, Johnson said. The nonprofit, which employs 50, does offer some services free of charge but only on a limited basis. Bridgehaven operated on a slight deficit between 2012 and 2014, before generating a surplus of nearly $7 million in 2015 — though that surplus fell by $2 million in 2016 and another $2.7 million in 2017, according to IRS records.

Passport has a broad provider reach: In 2017, more than 600 organizations received more than $100,000 in compensation from Passport, according to IRS records.

A recently retired local pediatrician said that Passport’s demise, coupled with the state’s planned changes to its Medicaid system, likely would prompt more local physicians to reduce the number of Medicaid patients they accept — or cut them altogether — which would make access to medical care even more difficult for Medicaid patients.

Dr. John B. Roth

Dr. John B. Roth, retired CEO of the Kaplan Barron Pediatrics Group, told Insider that physicians already have absorbed major rate reductions in the last two years and if he were still active, additional cuts would force him to refuse to see Medicaid patients — something he did for his entire 45-year career.

The money that physicians get for treating Medicaid patients does not cover the physicians’ cost of care, Roth said, which means they have to limit the number of Medicaid patients they see and supplement that shortfall with patients who have private insurance.

When Passport was forced to take disbursement cuts from the state last year, it lowered its reimbursement rate to the Roth’s pediatrics group, which lost the salary of one full-time physician. The group reduced all physicians’ salaries to be able to avoid cutting a physician’s position because otherwise, it would not have been able to handle its patient load, Roth said.

When local physicians have raised concerns, Passport officials have listened and have tried to help solve problems, Roth said. And the organization has surpassed other payers on promptness and has had lower rates on rejected claims.

Roth said that if Passport becomes insolvent, more than 300,000 Medicaid patients will have to find a new managed care organization, and many of them will have to find new doctors. And that will put pressure on the doctors who are in the new managed care organization’s network.

As those doctors have to turn patients away to remain profitable, the patients will have to travel farther to see other medical providers, putting even greater strain on an already taut system and, Roth said, putting even more hurdles into the path of people who desperately need care.