Q&A: Managed-care organization president talks Medicaid delays, April 1 launch date

Cynthia MacDonald is health plan president of Amerigroup Iowa, one of the three managed-care organizations awarded a contract to manage the state's $5 billion Medicaid program with more than 560,000 enrollees. MacDonald has more than 26 years experience working with government-sponsored health plans. She helped launch the Minnesota managed-care program in the late 1980s, has worked for the Centers for Medicare and Medicaid Services and Blue Cross Blue Shield of Minnesota. The Gazette spoke with MacDonald about the upcoming Medicaid transition on April 1.

During your 26 years in the industry, how has Medicaid managed care evolved?

Medicare and Medicaid recently celebrated its 50 year anniversary, and (their) evolution has been dramatic. I have watched that evolution during the most recent half of the program's existence, and all the changes that I have seen, I believe the most extraordinary involves the introduction of integrated care coordination that aims to treat the whole person and not just a disease after a person's health has deteriorated.

Through experience, managed-care programs have developed a better understanding of the specialized needs of their members and have implemented services, benefits and experts capable of addressing these needs. They promote the right care, at the right time, in the most appropriate setting.

It is now common for managed-care health plans to employ in-house psychiatrists, dietitians and social workers as well as to offer programs such as medical transportation, 24-hour nurse helplines, substance-abuse treatment, telemedicine and healthy families programs to ensure members have the tools they need to maintain and improve their health.

Iowa has hit a few bumps in its path toward moving 560,000 people over to managed care. Do you think the multiple Centers for Medicare and Medicaid Services delays were overly cautious or necessary?

Moving a large population of members to managed care requires a great amount of collaboration, coordination and communication, and we have been working collaboratively with our state partners and fellow managed-care companies to ensure a seamless transition.

We have been engaged in daily conversations with hundreds of stakeholders, and we respect the direction we have received from our regulatory partners.

We understand the criticality of being coordinated in our approach and the need to execute a flawless launch, so we have taken the additional time to continue developing our provider networks and strengthening our community relationships.

What has that extra time allowed Amerigroup to do?

A: We have been settled in our new offices (in Des Moines) for three months now and have been engaged in extensive training and outreach. We have conducted extensive preparedness training for all of our associates as well as with our provider partners.

We have been conducting role-modeling sessions where we consider a day in the life of a member. The discussions engage our own staff and our provider partners in collaborative dialogues that explore various scenarios, extraordinary circumstances and exceptions that may impact the lives of our members.

We have also been reaching out to our providers and vendors to ensure they know how to work with us — how to bill us and contact us when they need guidance. Additionally we have had the opportunity to develop relationships with people in our communities. We have attended and sponsored community events, such as KidFest, and look forward to continue meeting fellow Iowans and giving them the opportunity to learn more about Amerigroup.

The April 1 start date is less than two weeks away. Can you tell me a little bit about where Amerigroup stands in developing a provider network, setting up offices and hiring staff? Are there things left to do, or is the company pretty set?

We have not only built a robust network of providers capable of serving Iowans across the entire state, but we have also hired and trained hundreds of Iowans who live and work in the communities they will serve.

You may have read announcements about our recent agreements with network partners such as UnityPoint Health and Mercy Health Network. We are proud to say that we have developed relationships with the most highly qualified health providers in our state and credentialed professionals who currently serve Medicaid beneficiaries.

We are ready to launch services, and we plan to continue developing our relationships over the duration of our contract term. Additionally we are excited about the opportunity to continue growing our Amerigroup family of staff and members year over year.

There are obviously many patient and provider fears about this switch — some worry services will be cut or not approved. What would you tell a family who has selected Amerigroup to help relieve some of those fears?

We recognize that people may be uncomfortable with change, but we want to assure Iowans that we have put enormous effort into preparing for a smooth transition. Our top priority is our members, and we will work tirelessly to respond to their questions and help them access the services they need to become and stay healthy.

We also understand how important it is to keep the lines of communication open with our provider and community partners. They are our front line of support, so we have put a great deal of effort into making ourselves available to answer their questions and support their work.

For anyone who has concerns about our abilities, we want them to know that Amerigroup and our family of affiliated health plans have a long history of launching statewide Medicaid managed-care services and extensive experience serving more than 38 million health plan members across the nation. One in nine Americans receives coverage for their medical care through our affiliated health plans, and our decades of experience have positioned us well to provide tested, proven and best-in-class services to the people of Iowa.