Waianae Coast Comprehensive Health Center said it has failed to reach a payment agreement with Hawaii Medical Service Association for roughly 7,500 members of Quest, the government health insurance program for low-income residents.
Without an agreement the health center will no longer be a preferred provider in HMSA’s Quest network when its contract expires June 30.
"What it means for the patients is that we do not have the kind of partnership with HMSA that will allow us to work together to plan and develop new services for our patients," said Rich Bettini, the Waianae center’s chief executive officer. "However, if people do choose HMSA Quest, we will not turn them away. They will still get most of the medical services at the health center."
Waianae Coast estimates it will receive 30 percent less for serving HMSA Quest members as an out-of-network provider and will be forced to reduce programs and cut roughly nine positions in November. Affected programs include the Native Hawaiian Healing Center, Waianae Health Academy and the Adult Day Care Center as well as homeless and training services, education and outreach physicians, and administrative positions.
"We will take a financial hit," Bettini said, adding that the health center will try to make up the lost revenue through grants. "We’re going to have to take $500,000 off the books (annually)."
HMSA said it is still hoping to reach an agreement that’s in the best interest of Quest members.
"Regardless of the outcome, HMSA Quest members will continue to be able to go to the health center, and HMSA will continue to pay for the services they receive there," HMSA spokeswoman Elisa Yadao said in a statement.
Health insurers get on average $2,500 per member per year for Quest members. The state Department of Human Services manages the Medicaid (Quest) health insurance program for 250,000 members.
"Our interest is ensuring that our beneficiaries have no interruption in their care," said Kenny Fink, administrator of the state Department of Human Services Med-Quest Division. "It is our understanding that there will be no change in access to care for Medicaid beneficiaries at Waianae Comp, and they will not need to pay any co-payments or other cost sharing."
Bettini said HMSA didn’t respond to the health center’s proposal on a new payment model by a Monday deadline.
The payment model involved HMSA investing money upfront to help Waianae Coast build a so-called patient-centered medical home, a team-care model that seeks to coordinate services among a group of providers. The health center’s proposal also sought to share any savings realized between both parties if the center could reduce costs such as emergency room visits or hospital readmissions, Bettini said.
Waianae Coast Comprehensive Health Center has a total annual operating budget of $50 million and employs more than 600 people, mostly area residents. It sees more than 20,000 total Quest patients annually.
"We have already gotten hundreds of calls from our patients," Bettini said. "They are confused because they know that we don’t have a full partnership with HMSA. The single most important thing is if you’re in Quest and are in any of the plans, we will see you. The only difference is our situation with HMSA is not pono (right). We are not partners."
The new open enrollment period for Quest will run through June 28.
