By Rob Waters
September
26, 2018
[UPDATED on
Sept. 27]
Whipsawed
is not a medical condition, but it describes exactly how Lee Henderson feels
about his on-again, off-again care at UC Davis Medical Center, a place he’s
been visiting since he was a child.
For the
second time in three years, Henderson is about to lose access to his primary
care team at the Sacramento institution.
When
Henderson had surgery there in 2015 to remove an adrenal gland that was
severely elevating his blood pressure, he was covered by Health Net, the only
Medi-Cal managed-care plan in Sacramento County whose members could go to UC
Davis for primary care at the time.
But
shortly after his surgery, Henderson learned that his insurer and the
university were terminating their contract, forcing him and an estimated 3,700 other Health Net Medi-Cal
members to leave UC Davis and find new primary care doctors.
Now,
history is repeating itself. After briefly regaining access to UC Davis last
year, when UnitedHealthcare entered the Sacramento Medi-Cal market and signed
an agreement with the medical center, Henderson and 1,000 other patients are
getting booted out again.
On July
25, those patients got a letter from
UnitedHealth. “Dear member,” it began, “we’re writing to let you know that our
Medi-Cal services in Sacramento County will be discontinued effective October
31, 2018.”
The
letter, Henderson said, “was the equivalent of getting slapped in the face —
twice.”
Medi-Cal,
California’s version of the federal Medicaid program for low-income residents,
serves 13.5 million people, about one-third of the state’s population. The vast
majority of them — about 80 percent — are served by managed-care plans, in
which the state pays insurers a fixed amount per enrollee to provide
comprehensive care.
That
contrasts with fee-for-service Medi-Cal, in which the state pays medical
providers directly for services provided. Medi-Cal enrollees are generally required
to sign up for managed care.
The
exit of UnitedHealth from Sacramento County’s managed-care Medi-Cal program
means that, once again, no Medi-Cal patients on managed-care plans in the
county will be able to go to UC Davis for primary care.
Patient
advocates think UC Davis shares equal blame for the problem.
Dr.
Richard Pan, a Democratic state senator representing Sacramento and a
pediatrician who used to practice at UC Davis, is taking on his former
employer, as he did when the Health Net contract ended.
“Why is
a public, state-owned university that’s running a health system not contracting
with the state health plan?” Pan wants to know.
UC
Davis spokesman Charles Casey said the medical center is “deeply disappointed
in UnitedHealth’s actions, as we understand how disruptive it is when care is
interrupted for patients.” The university is working to negotiate other
Medi-Cal contracts and hopes to have something to announce by Oct. 31, he said.
At the
core of the issue is money. UC Davis has complained for years about low Medi-Cal reimbursement rates.
Casey said that in 2017 the health system absorbed more than $93 million in
unreimbursed costs serving Medi-Cal patients.
Pan,
who now chairs the Senate Health Committee, said the structure of Medi-Cal
managed care in Sacramento, which gives enrollees the choice of multiple plans,
was a lose-lose for UC Davis and UnitedHealth, because the sickest, most
expensive patients wanted to be on a plan that gave them access to the medical
center.
“You
get all the sick people — asthma or cancer or sickle cell,” he said. “The
Medi-Cal contract did not account for the fact that you have a sicker
population.”
Catherine
Farrell, a UnitedHealthcare spokeswoman, did not give a specific reason for the
company’s withdrawal from Sacramento County. But she noted in a written
statement that “reimbursement rates remain an important topic.” The company
will continue to serve Sacramento residents in Medicare and commercial plans,
she said, and to offer Medi-Cal managed care to its enrollees in San Diego
County, who currently number 7,000.
UnitedHealth’s
July 25 letter said the company had made its decision “after a review of
member, county, state, and business needs.” Earlier that month, UnitedHealth
Group reported profit of $3.01 billion for the second quarter, a 28 percent
increase over the previous year.
But
Medi-Cal is hardly a pillar of its business strategy.
The
company’s 4,400 patients represent just 1 percent of the 422,000 Sacramento
residents enrolled in Medi-Cal managed-care plans. Anthem Blue Cross insures
175,000 and Health Net covers 104,000. Kaiser Permanente, Molina Healthcare and
Aetna account for the rest. In San Diego, the only other county in the state
where it offers a Medi-Cal plan, UnitedHealth has about 1 percent of that
market. (Kaiser Health News, which produces California Healthline, is not
affiliated with Kaiser Permanente.)
The
displaced UnitedHealth patients in Sacramento will be able to choose among the
five other Medi-Cal carriers, said Brenda Bongiorno, a spokeswoman for the
county health department. Those who don’t make a choice will be assigned a new
insurer, she said.
The
sudden loss of access to the broad and highly skilled network of doctors at UC
Davis is especially hard for patients with complex conditions, said Elaine
Abelaye-Mateo, a community advocate with the Health Access Action Team of Sacramento
Building Healthy Communities, a nonprofit group working to improve local
health.
“They’re
already vulnerable,” Abelaye-Mateo said. “Now they’re left to scramble and
figure out where to go.”
Gail
Cleveland is a case in point. The 59-year-old Sacramento resident was diagnosed
with diabetes at 19, has chronic heart disease and had radiation therapy in
2001 for cancer wrapped around her spinal cord. Several years ago, she lost her
ability to walk.
She had
been getting treatment at UC Davis Medical Center for decades and had the same
primary care doctor there for 15 years until the Health Net Medi-Cal contract
ended.
She
declined to name her new doctor, but said her care has deteriorated since then.
“I
really do feel that if I had gotten the correct medical attention that I had
been getting at UC Davis, things would be different,” she said. “Now I’m
fighting for my life.”
[Correction:
This story was updated at 12:15 a.m. PT on Sept. 27 to correct the amount that
UnitedHealth Group reported as profit for 2018’s second quarter.]
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