Fri., September 13, 2013 10:00am (EDT)

No HMO For Metro Atlanta State Workers
By Andy Miller, Georgia Health News
Updated: 10 months ago

ATLANTA  —  
In an unexpected move, a state agency’s board has rejected a proposal to offer an HMO option to state employees in seven metro Atlanta counties. The 6-3 vote Thursday by the Department of Community Health board reflected opposition to offering a choice of health plans in metro Atlanta but not in other areas of the state. (Photo Courtesy of forwardcom via stock.xchng.)
In an unexpected move, a state agency’s board has rejected a proposal to offer an HMO option to state employees in seven metro Atlanta counties. The 6-3 vote Thursday by the Department of Community Health board reflected opposition to offering a choice of health plans in metro Atlanta but not in other areas of the state. (Photo Courtesy of forwardcom via stock.xchng.)
In an unexpected move, a state agency’s board has rejected a proposal to offer an HMO option to state employees in seven metro Atlanta counties.

The 6-3 vote Thursday by the Department of Community Health board reflected opposition to offering a choice of health plans in metro Atlanta but not in other areas of the state.

Kaiser Foundation Health Plan of Georgia emerged as the winner of a separate, “regional” HMO contract for the state health plan, Community Health officials said Thursday before the vote.

Board member Richard Jackson said the regional option created a problem of inequality. “To me, all people should have options,’’ he said prior to the vote.

The Community Health board decision continues the turmoil surrounding the lucrative contract for the state employee plan.

The agency has already chosen a single insurer, Blue Cross and Blue Shield of Georgia, to provide a statewide PPO for members of the State Health Benefit Plan (SHBP), which covers more than 650,000 state employees, teachers, other school personnel, retirees and dependents.

That award, though, is under appeal by UnitedHealthcare, which has called the contracting process “state-sponsored bid-rigging.’’ Community Health has denied that claim.

Trudie Nacin, a DCH official, explained to board members Thursday that the Kaiser contract would cover only Fulton, DeKalb, Gwinnett, Rockdale, Clayton, Fayette and Henry counties, where more than 80,000 employees in the SHBP live.

Nacin said Kaiser was the only HMO insurer that showed it would save money for the SHBP under a regional option. If 5 percent of eligible members enrolled in Kaiser, she said, the state would save $2.9 million. The savings would double if 10 percent enrolled.

Community Health board member Clay Cox said before the vote that he understood “the equity aspect of the issue,” but added that he still would vote for the HMO option to give choice to state employees in metro Atlanta.

Kaiser last held a contract for the SHBP in 2009, and had thousands of members.

Kerry W. Kohnen, president of Kaiser Permanente of Georgia, said in a statement that the nonprofit health care organization is “extremely disappointed’’ by the board vote.

“DCH asked for, and we delivered, a strong, innovative proposal that guaranteed improvement in wellness and prevention and would have saved the state millions of dollars,’’ Kohnen said in the statement.

“Kaiser Permanente served state employees for 20 years until 2009 and had the highest member satisfaction among the health plans offered,’’ he said. “ We consistently rank highest in the state in health plan measures of quality and service. State employees in Metro Atlanta continue to ask that Kaiser Permanente again be offered as an option.”

Kohnen added, “We see no plausible explanation for today’s decision.”

United and Cigna currently hold the contract for the SHBP.

The board vote leaves the issue of the United appeal still up in the air. Community Health said Thursday that no final decision has been made on the appeal.

United, which covers most of the policyholders under the current SHBP contract, has mounted a strong attack against Community Health’s actions, saying the department has not produced all relevant documents under the Open Records Act and conducted a “secret’’ bid for the regional contract.

Last month, a Fulton County judge rejected United’s request to halt the implementation of the statewide contract to Blue Cross while it is under appeal.

The state aims to start open enrollment for employees Oct. 21. State officials have pointed to major savings under the single Blue Cross contract.

Recently, medical providers have expressed concern that they would get lower payments if there is a single statewide insurer for the SHBP, especially given the level of savings that the state expects.

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