Providers rank MCO performance in Pierce County

State Senator Steve O’Ban sent a letter to the Health Care Authority (HCA) at the beginning of June, detailing the results of a recent provider survey ranking the performance of managed care organizations (MCOs) in Pierce County. The survey and letter, which was sent on behalf of the Integration Oversight Board (IOB), was in response to a recent HCA request for proposals which opened the door for a new MCO to operate in Pierce County.

HCA currently has contracts with five MCOs – four of which operate in Pierce County. The RFP is seeking bids from currently contracted MCOs to operate in additional regional services areas (RSAs).

 

 

For Pierce County specifically, the RFP creates an opportunity for Community Health Plan of Washington (CHPW) to operate in the county.

In the letter, O’Ban writes that during a recent IOB meeting, some providers welcomed the prospect of CHPW while others were concerned about having to adapt to a 5th MCO.

“However, what nearly all providers could agree on was that the HCA consider removing substantially underperforming MCOs from the regionally approved list, or at a minimum reopen the competitive process,” wrote O’Ban. “Consistent with that objective, providers would almost certainly welcome CHPW if it could demonstrate its responsiveness to providers.”

In response to the RFP, Elevate Health conducted a survey of behavioral health providers in Pierce County for their input on MCO performance. The survey received responses from inpatient and outpatient behavioral health providers as well as Medication-Assisted Treatment (MAT) providers. Providers were asked to rank the four managed care organizations operating in Pierce County in a series of performance areas.

In terms of overall performance, Molina Healthcare ranked highest with 7 providers choosing it as the top performer and one provider ranking it as the worst. Next on the list was Amerigroup (four top rankings, two bottom rankings) and Coordinated Care (2 top rankings, 0 bottom rankings). Seven providers ranked United Healthcare as having the worst overall performance, while three said United had the best performance.

 

 

Molina also performed well in terms of providers’ experience getting claims paid timely, on quickest to pay Accounts Receivables of more than 90 days, and on how quickly they work to respond to issues or concerns reported by providers.

 

 

Overall, providers ranked Amerigroup and United at the bottom for getting claims paid in a timely way and for quickly addressing concerns and resolving issues.

Another question asked providers to rank MCOS on their performance in meeting the needs of clients such as referrals and authorizations. For this question, Amerigroup, Coordinated Care, and Molina had similar rankings, but United was last with 7 providers putting them at the bottom.

The survey also asked providers to select an MCO that they believe should be dropped as an approved MCO for the region. Five said United should be dropped, 3 chose Amerigroup, 1 chose Coordinated Care, and 0 chose Molina. Three providers reported that none of the MCOs should be dropped.

HCA Director Sue Birch responded to the letter by explaining the actions being taken to improve the accountability of Integrated Managed Care plans, stressing that the HCA will not hesitate to take “strong and immediate action” if necessary.

“However, conducting a complete re-procurement on the heels of the final phase of integration, and in the midst of a pandemic, was not a preferred option given the disruption it could have on the system and providers. HCA may indeed take that step in the future, depending on the results of the current procurement and MCO performance improvement in the future,” wrote Birch.

Apparently successful bidders of the RFP are set to be announced July 29, according to an amendment of the RFP.