Eastern Iowa agencies losing health care workers to managed-care organizations

As the four managed-care organizations awarded contracts to handle the state's $5 billion Medicaid program rush to fill hundreds of positions in time for the Jan. 1 launch date, some area not-for-profits and county departments are seeing their case managers, nurses and social workers turn in resignation letters to go work for those private companies.

It isn't necessarily a higher salary enticing some of these employees away, but a secure job.

Agencies are unsure of the future of case management services as several of these managed-care organizations have indicated they plan to offer those services themselves rather than contract with existing organizations.

Even still, the vacancies are forcing agencies to shuffle clients around as well as increasing the remaining employees case loads.

Case managers work with individuals to coordinate services and find helpful resources, from home health resources and meal delivery to skilled health care services such as physical or occupational therapy.

The Abbe Center and its affiliates, which offer mental health and aging services, has had about 14 employees leave the organization in the past couple months to work for a managed-care organization, said Dan Strellner, the organization's president.

The employees who left were nurses or social workers, he said, and the majority worked with individuals involved in Abbe's mental health programs or Integrated Health Homes - a team of professionals who provide coordinated care for adults with a serious mental illness.

Strellner said Abbe has been able to fill a few of those vacancies already, but it is relying on existing staff to fill the gaps.

'Given the current health care workforce shortage, it's becoming increasingly difficult to replace” workers, he said.

Michelle Dhondt, chief executive officer of Mental Health and Disability Services of the East Central Region, said she's lost about six case managers and is working to shuffle cases to other employees so those individuals continue to receive services.

She said the agency, which works with adults in a nine-county region that includes Linn and Johnson, still is talking with AmeriHealth Caritas Iowa, Amerigroup Iowa, UnitedHealthcare of the River Valley and WellCare of Iowa to see if those companies plan to contract case management services or do them internally.

'We don't know if case management will be lost,” she said, adding the staff members who chose to leave are 'trying to get out ahead of it.”

'It's a transitional period,” she said. 'It's an interesting time. I don't know it will turn out, but we'll be ready either way.”

Maggie Beavers, coordination supervisor at Linn County Mental Health and Developmental Disability Services, said about nine of her 33 cases managers have left to work for a managed-care company.

'There were some (case managers) whose case loads weren't fully developed,” Beavers said. 'So we've been able to spread people around.”

Employee case loads are higher than she'd like but still meet state rules and guidelines, she said.

'We can't see people as much as we'd like.”

But this shift happening in Iowa is not unique. At Monday's Health Policy Oversight Committee meeting in Des Moines, a case manager working for Amerigroup Kansas talked about a similar situation having occurred in 2013 in Kansas as that state moved to managed care.

'It was a painful transition - most case managers went to the MCOs,” said Lisa Simon, a service coordinator for Amerigroup Kansas, during the public comment portion. 'We still saw a lot of the same clients, and I can see the people I need to see. ...

Some small agencies decided to not do that service anymore”

That's what's happening at Circle of Friends Home Care in Chariton, a town of about 4,300 in south-central Iowa.

Amanda Schroeder, nurse administrator at Circle of Friends, said two case managers have left to go work for a managed care organization and the agency - which offers home health services, home and community based services and respite care among other services - ultimately has decided to stop offering case management to elderly Medicaid recipients all together.

'We're scrambling to shed as many clients as we can to other case management providers,” she said.

Schroeder said she doesn't fault the employees who left - they're very interested in case management, she said, and feared they'd be out of a job.

Circle of Friends is working to contact the 200 or so individuals it works with who will be affected to explain to them what is happening. Case management makes up about 10 percent of the agency's budget.

'We'll take a hit, yes,” she said. 'But I hate to lose those services for the members. We were doing a good job.”