New QUEST Medicaid program is a major step forward

Factual errors about the state's new QUEST Expanded Access (QExA) Medicaid program are popping up in various media outlets. To set the record straight, here are some facts:

» Under QExA, more than 37,000 low-income seniors and people of all ages with disabilities -- who currently navigate the Medicaid system alone -- will benefit, for the first time, from a comprehensive continuum of coordinated healthcare.

» QExA clients will be helped by a team of healthcare professionals, including service coordinators.

These high-need patients will have easy and timely access to primary care physicians and specialists, as required in great detail under the contracts.

» Clients will benefit from additional health services, such as programs for home-based care, diabetes, heart disease, obesity and more.

» QExA will fully protect patient rights, aided by new ombudsman services, enrollment counseling and an extensive quality assurance system.

» There will be no breaks in coverage when clients move into QExA.

» Likewise, there will be no breaks in service. Every client will keep the same medical services for at least 90 days, or until the health plan completes a comprehensive assessment of the patient's needs.

» Under the QExA contracts, 93 cents out of every dollar paid to the health plans must be used for client services, with only seven cents retained for administrative costs and profits.

» Physicians and other providers will receive higher reimbursements because Medicaid rates will increase on July 1 and become the guaranteed minimum. To simplify the transition, doctors can use current billing forms.

Much of the misinformation about QExA is being circulated by AlohaCare, which did not win a competitive bid contract and now seems intent on causing the program to fail. This same misinformation is mirrored in a lawsuit filed by the Hawaii Coalition for Health.

The public should understand that AlohaCare's attempts to overthrow the QExA contracts were rejected three times: first by the Department of Human Services, second by the independent State Procurement Office and most recently by Federal Judge Susan Oki Mollway on June 18.

Despite these defeats, AlohaCare and its close affiliates continue to alarm Medicaid clients, disparage the state and the winning health plans, and create confusion among healthcare providers, the public and the media. Here are some additional facts:

» Contract winners Evercare and Ohana Health Plan have maintained significant operations in Hawaii for several years. While the Star-Bulletin stated "a coalition of doctors and patients are worried because the companies do not have significant operations in Hawaii," these worries are unfounded.

» Evercare has the state's third-largest Medicare plan, behind HMSA and Kaiser. Ohana Health Plan's parent company, WellCare, operates one of Hawaii's original Medicare Part D plans.

» All key health plan staff and most other personnel are required to live in Hawaii, under the QExA contracts.

» The state conducted an extensive vetting process before awarding the contracts. This included contacting government officials in 26 states where the two winning bidders serve Medicaid patients, and examining federally mandated performance and quality assurance reports regarding these health plans. The parent companies of Evercare and Ohana Health Plan have never had a contract revoked or been precluded from continuing to seek and obtain new business.

» The reason the state delayed the start of QExA until Feb. 1, 2009, is to ensure that clients, physicians, quality assurance staff and all other participants are fully prepared to make a seamless transition.

AlohaCare's misinformation campaign is apparently the reason why the Star Bulletin's June 20 editorial incorrectly stated that the QExA "$1.5 billion contract is (being) transferred from a local nonprofit health plan."

This error has been repeated elsewhere. Evercare and Ohana Health Plan hold the first and only QExA contracts. There are two contracts, not one, and neither contract could have been transferred from AlohaCare or any other health plan, because QExA is a brand new program.

Bottom line, moving elderly and disabled clients into a coordinated system of care is a major step forward -- a step first envisioned in 1994 when QUEST began. Nearly 200,000 Medicaid clients already receive the benefits of managed care through QUEST. It would be unconscionable to continue denying this type of quality care to our most vulnerable clients.

QExA members will greatly benefit from an emphasis on preventive and proactive care. Also, the state will closely monitor the health plans through a quality assurance system tailored for QExA. As a result of this intensive oversight, our taxpayers will be assured that they are getting quality programs and that our clients are receiving the care they deserve.

When QExA "goes live" in February, it will be a success from Day One. And the winners will be our Medicaid clients, who will enjoy better care and improved health outcomes.