THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Wednesday, December 27, 1995 TAG: 9512270064
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Medium: 65 lines
On the first day of the new year, Hampton Roads will become a kind of social services laboratory, testing whether private companies can do a better - and cheaper - job than the government at providing medical services to poor people.
As of Jan. 1, most local Medicaid recipients, about 92,000 people, will find their health care in the hands of a few health maintenance organizations. Suffolk is the only local jurisdiction not included in the project.
The idea for the program already has been used in many other states. Ideally, it will mean that poor people will get better care and taxpayers will spend less for the program. If it works here, Hampton Roads likely will become the model for the rest of Virginia.
To succeed, however, the insurance companies must change the way many poor people get treatment. Clients must build a relationship with a family doctor and stop using the emergency room for problems that could be handled in a doctor's office.
During 1995, clients were allowed to choose from among several HMOs approved by the state. Those who didn't pick one - about half the eligible group - have been assigned an HMO based on a formula designed to let clients stay with their regular doctor, if they have one, said Thomas McGraw, head of the managed care program for the state Medical Assistance Services department.
About 15,000 elderly recipients who also use Medicare will be assigned to HMOs later in 1996. Clients in nursing homes or in other special circumstances won't be put in the program.
The Hampton Roads health care industry has already noticed some effects from the shift.
In the past few months, Children's Hospital of The King's Daughters in Norfolk has seen a drop in the number of beds filled. At times, occupancy has fallen below 75 percent, ``which is almost unheard of in our organization,'' said Lawrence Bates, the hospital's vice president for managed care.
About half of King's Daughters' business comes from Medicaid patients, an unusually high percentage. The hospital expects big changes, since HMOs keep costs down by keeping clients out of the hospital.
To prepare, CHKD has formed a network of doctors that will contract directly with the HMOs to care for clients.
And some of the hospital's doctors will begin seeing Medicaid patients at the Norfolk Health Department's Little Creek clinic, said a hospital spokesperson.
Beyond that, the hospital, along with the HMOs, may have to educate clients to focus on prevention and break the emergency-room habit. Medicaid clients tend to use the emergency room for basic health care, which is expensive. Often, clients don't have transportation to get to a doctor's office, they can't find a primary care doctor who will accept Medicaid, or they aren't aware of their options.
``There are some logistical problems the Medicaid population is not used to dealing with,'' said Pam Brunner, director of managed care for King's Daughters. Even so, she said, staff support the move to privatize Medicaid because they believe it will be better for patients. by CNB