ANOTHER CURVE BALL IN HEALTHY OPTIONS RFP: GROUP HEALTH

As we previously discussed, Group Health, along with fellow Healthy Options plans Regence and Kaiser, decided not to bid on the new Healthy Options RFP.

However, Group Health sent out a press release today stating that they intend to continue serving Healthy Options patients in conjunction with another plan — although they did not indicate which plan.  Here is the full release:

Group Health Cooperative declined to participate in the state bidding process for administering the Medicaid Healthy Options health plan, as the rules within the state’s new program were not crafted to work well with an integrated medical system, which combines health plan coverage with delivery of care.

Group Health intends to continue to provide medical care to Healthy Options patients in its medical centers in partnership with another health plan.

“We see our participation in Healthy Options and other state programs that serve low income populations as part of our mission,” said Pam MacEwan, vice president for public affairs and governance. “Group Health has participated in Healthy Options, the managed Medicaid program, molland Basic Health, since the programs were created.”

The key issue with the state’s new rules for managed Medicaid is a provision that prevents health plans from limiting the number of enrollees they accept. Because Group Health is both a health plan and a provider delivery system, the new rule would require Group Health providers to accept unlimited Medicaid enrollment. This would place Group Health providers outside the norm of other provider practices and create financial challenges and unsustainable risk for the organization. Group Health currently serves about 27,000 Health Options and Basic Health patients.

Group Health as not yet selected a health plan partner or partners. The new Healthy Options and Basic Health contract goes into effect July 1, 2012.

“We intend to continue to serve these patients in our medical centers. They will continue to have access to their online medical records and many other Group Health features that help all Group Health patients get timely care and live healthy lifestyles,” MacEwan said. “We will make every effort to create a seamless transition for patients as we move them to another health plan.”

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