THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Saturday, August 13, 1994 TAG: 9408130327
SECTION: BUSINESS PAGE: D2 EDITION: FINAL
SOURCE: BY LON WAGNER, STAFF WRITER
LENGTH: Medium: 51 lines
Sentara Health System this fall plans to offer a health care plan to women and children eligible for Medicaid.
Sentara, the largest health care company in Hampton Roads with profits last year of $30 million, will step into a side of managed health care never before explored in Virginia.
The result could improve health care especially for poorer families who now rely on hospital emergency rooms for medical care.
Health care agencies in the state have stayed from such plans, partly because of low reimbursements to physicians who treat Medicaid patients.
``We're not expecting to make much profit out of this,'' said Sentara's chief operating officer, Ted Wille.
``But we expect to better serve the population.''
Virginia's Department of Medical Assistance has cleared the way for health care providers to form health maintenance organizations, or HMOs, for Medicaid patients. Sentara expects other providers to set up similar plans.
Although 150,000 Medicaid recipients live in Sentara's market of Hampton Roads, the state has allowed hospitals to set up HMOs only for women and children on Medicaid. That gives Sentara 70,000 potential patients for its new plan.
Kathi Saunders, Sentara HMO project manager, said the state insisted on only women and children in the HMO because they would benefit the most.
Prenatal care, for instance, could not only save a woman from difficulties later in her pregnancy, but also save overall health care expenses.
After looking at Virginia's health statistics, one HMO association realized the high rate for neo-natal intensive care could improve if the state's 21 HMOs educated mothers.
``We think the HMOs may have some things to offer that may help their health as well as save their money,'' said Tom McGraw, the state's director of alternative health care.
``With our clientele, a lot of them have never had a primary doctor, so we're trying to get them a medical home.''
One Virginia HMO had already submitted a contract to start serving Medicaid patients, McGraw said.
Sentara plans to submit its contract soon, and wants to start offering the HMO in late fall or early winter, Wille said.
KEYWORDS: HEALTH CARE INDIGENT HMO MEDICAID by CNB