- The Washington Times - Thursday, April 19, 2012

D.C. Council member David A. Catania put forth game-changing proposals Thursday intended to save money in the District’s public health care framework — one to scrap the city’s managed care system and another that requires many low-income patients to start paying monthly premiums for services “so that everyone is pulling the wagon.”

The District has contracts with two managed care organizations, United Healthcare and D.C. Chartered Health Plan, which are paid specified rates and direct patients to health care services within their provider networks. The popularity of managed care systems in the United States has grown in recent decades because state officials feel the organizations have a profit incentive to run efficiently and control costs.

But Mr. Catania, at-large independent and chairman of the Committee on Health, said these organizations “in my mind, have not succeeded in the District.”

“They’ve neither managed care nor cost,” he said.

Mr. Catania’s proposal, which at this point is merely a suggestion from the dais, would install a traditional “fee for service” model in which providers would be paid by the District for each Medicaid-eligible service they perform. One witness mentioned Thursday that Connecticut recently bucked the national trend by getting rid of its managed care system.

Throughout the hearing, Mr. Catania indicated that he is losing patience with the city’s pair of managed care organizations. The law requires the District to have at least two, and fear of losing either of them effectively kills their bargaining power when the provider asks for higher rates, he said.

Wayne Turnage, director of the D.C. Department of Healthcare Finance, said the city is putting out a request for proposal to add a third managed care organization.

Mr. Catania’s proposal to eliminate the managed care system is “a debatable point” that can be discussed within his agency, Mr. Turnage said. National opinion indicates managed care systems typically save money, but he noted that talks with the District’s managed care organizations often dissolve into arguments over rates.

Chartered Health has one year left on its $322 million contract with the city. The contract is under scrutiny because Chartered is owned by Jeffrey E. Thompson. The prolific political donor found himself entangled in a federal investigation into campaign finance practices when his home and accounting firm were raided on March 2.

Mr. Thompson, his companies and associates from across the country have donated to every sitting elected official in the District except council member Tommy Wells, Ward 6 Democrat, and given thousands more to Maryland Gov. Martin O’Malley, Virginia politicians, Atlanta Mayor Kasim Reed and additional candidates at the federal level, according to campaign records and news reports.

Scrutiny of his fundraising has mounted in recent months after reporters found a consistent pattern of giving from his network on specific dates. The donations included money orders from different donors that had sequential serial numbers and similar handwriting to the untrained eye.

Mr. Thompson stepped down from the plan’s board of directors this week, and Chartered CEO Maynard G. McAlpin indicated that he is working with one of the largest health plans in the country to purchase Chartered within about 60 days, Mr. Turnage said.

Mr. Turnage noted that if the deal does not go through, the city should “end our relationship” with Chartered and bring in two new managed care organizations instead of one.

Mr. Thompson, through Chartered, has engaged in tough negotiations with city officials in the past, including a request for millions of dollars as part of a rate adjustment during budget talks last summer.

“I don’t know how much longer we have to make concessions for one person,” Mr. Catania said at the hearing. “And everyone in this room knows exactly what I’m talking about.”

Additionally, Mr. Catania said it might be time to impose a nominal premium on members of the D.C. Healthcare Alliance in light of significant cuts in Mayor Vincent C. Gray’s budget plan for fiscal 2013.

The mayor’s plan cuts $23 million in hospital and specialty care from the alliance, which provides care to more than 20,000 low-income people — almost all of them immigrants -who are not eligible for Medicaid.

“The alternative is that there would be no services,” Mr. Catania said. “The taxpayers can’t afford any more, and if we don’t think of things a little differently we’re going to lose these programs.”

Mr. Catania said a hypothetical payment of $25 per month does not sound like much, but multiply it by thousands of residents “and all of sudden it turns into real money.”

He said he does not want to burden a vulnerable population, but “I think there’s a value to the notion of paying something.”

“I think it’s time,” he said, “that we start mainstreaming responsibility across the board.”

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