Sunrise health care firm aims to cut Medicaid costs

Feb. 10--Sunshine Health, a Sunrise managed health-care company that was a big winner in Florida's long-term care contracts last year, is doubling its workforce in South Florida to provide services to low-income seniors and the disabled.

The company said it is on a mission to provide improved health care to the low-income and disabled communities at a reduced cost to government.

Preventative care is the key, said Chris Paterson, chief executive for Sunrise-based Sunshine Health.

"We try to identify members who will need more help than others," he said.

Sunshine Health, which also provides other Medicaid services, has a total of 215,000 residents under its care in the state, with one-third of them in South Florida.

In 2013, the company bid and won contracts for 10 of the 11 regions in the state, including Broward and Palm Beach counties. It will share in providing long-term care for the approximately 90,000 residents eligible for Medicaid services.

In total, Sunshine has won $16 billion worth of contracts over five years to provide medical assistance and long-term care to Florida's Medicaid population, the Florida Agency for Health Care Administration said.

To expand its services, Sunshine Health is hiring up to 800 nurses, social workers and other health care professionals in South Florida. They will be mostly in the field providing services such as nursing, medication management or physical therapy.

Another 600 specialists for Cenpatico, a behavioral and foster care company owned by the same parent firm, will be hired over the next six months, the company said.

Sunshine Health uses a cost-reduction model for providing health-care services developed by parent firm Centene Corp., which operates in nearly 20 states. The St. Louis-based Fortune 500 company is known for its proprietary database called "Centelligence" that helps predict the likelihood a patient will need costly hospital or emergency care.

Nathan Landsbaum, senior vice president for Sunshine Health, gives the example of a patient who has been in the hospital twice during the past 30 days for a chronic condition such as diabetes. He said Sunshine Health helps the patient better manage their medical condition. If transportation is a problem, the company provides a ride for doctor visit or a medical test.

"People wait to the point where they absolutely need health care in an emergency setting. It may have been avoided if they had a test," he said.

Florida's private contracts for long-term care and other Medicaid services are part of the state's effort to cut costs from the government program known for bloat and fraud. Gov. Rick Scott sought and received a waiver from the federal government to implement a statewide privatization program.

Sunshine Health's mission includes working to transition individuals who want to move from nursing homes to assisted living or a private home when there is family support.

Edith Lederberg, executive director of the Aging and Disability Resource Center of Broward County, said Paterson seems to be listening to her and others in the community. Competitor Humana also has reached out to the nonprofit agency that monitors senior services, she said.

She recently talked with Paterson about the importance of paying for adult day care in keep seniors out of more expensive nursing homes. Providing adult day care "is a humane and financially sound alternative to try to keep the person in the community as long as possible," she said.

Dr. Michael Gervasi, who treats patients in Palm Beach County who are members of Sunshine Health, said the company has been supportive of paying for what he needs for patients, such as seeing a specialist.

"They let us practice," he said.

The state said it will begin monitoring companies given the long-term care contracts in July. Measures, targets and penalties are in place to ensure quality care, said Michelle Dahnke, spokeswoman for the Agency for Health Care Administration in Tallahassee. Consumers also can file complaints online or by calling the agency.

Managed-care plans for long-term care and Medicaid services run several risks, said James Sheehan, former Medicaid Inspector General for New York, who examined consumer complaints about such plans in 2013.

The complaints point to concerns that include cherry-picking mostly healthy enrollees, refusing to enroll individuals with likely upcoming expenses, disenrolling expensive patients, denying medically necessary care and contracting with unlicensed or unqualified providers.

Under Florida's plan, eligible residents got the opportunity to choose a long-term care plan in their region. If they didn't choose, they were assigned a plan. Even then, patients can opt for another plan after a waiting period.

"There are lots of opportunities to choose," Dahnke said.

While Sunshine and other plans can't market to residents, they are allowed to offer extra benefits at no extra cost to the state. Sunshine, for example, offers adult dental services and pays toward the transition of a patient from a nursing home to assisted living or home-based care.

"This is the sweet spot in procurement," said Dahnke of the Agency for Health Care Administration. "When all the plans got to a certain stage, the agency wanted to see what more we could get them to provide at no additional cost to the state."

While a relatively new managed-care company in the state, Sunshine Health has its roots in Access Health Solutions, a physicians network that it acquired. That company had been operating in South Florida since 2006.

Sunshine Health, like other Centene companies, make it a point to get involved with local community organizations.

Sunshine has provided pregnancy prevention and diabetes education at the Urban League's community centers. And last year, the company made a $2 million donation -- the largest one-time donation in the organization's history.

"The relationship we've had so far has been positive," said Germaine Smith-Baugh, chief executive of Broward'sUrban League, which works to help blacks and other disenfranchised groups achieve social and economic equality.

In 2013, parent firm Centene was given the National Urban League's first award for "innovation in health," citing the company's locally based approach and development of programs to reduce the number of premature births and babies born with low birth weight.

Smith-Baugh asked Paterson, who sits on her board, to head the research for a special report last year. "The State of Black Broward: Health Report" points to inequities in the county's health care. For example, black infants die at three times the rate of white or Hispanic babies in the county.

Now Paterson said he'll work with others in the community to come up with solutions. Sunshine's data analysis can help, he said.

"Our objective is to take our information and improve health care," he said.

mpounds@tribune.com or 561-243-6650

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