St. Luke’s sees little change for Mayo relationship after clinic doesn’t sign with managed-care orgs

March 26--Despite the news that the Mayo Clinic has opted to not sign contracts with the three managed-care organizations that will provide insurance to the state's 560,000 Medicaid recipients, UnityPoint Health-St. Luke's Hospital does not anticipate the move will alter its relationship with the specialty clinic through the Mayo Clinic Care Network.

The state will move its $5 billion Medicaid program over to three out-of-state, private insurers on April 1.

St. Luke's -- the only Iowa hospital part of the Mayo network -- receives health care consulting on difficult and complex cases from the Rochester, Minn.-based medical research organization. St. Luke's physicians are able to consult with Mayo Clinic on treatment recommendations and reference materials.

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"The goal of the Mayo Clinic Care Network is to provide UnityPoint Health-Cedar Rapids with a clinically meaningful relationship and the ultimate goal is to keep patients at home, in the Cedar Rapids community, receiving medical care in their home community with providers they already have an established relationship with," the hospital said in a statement in response to questions from The Gazette.

The Mayo Clinic news came out during Wednesday's Senate Human Resources committee meeting, where state senators met with the three chiefs of the MCOs.

The Mayo Clinic told The Gazette it will "work with Medicaid-eligible patients in Iowa and their managed-care organizations to make this insurance coverage transition as smooth as possible." In addition, if specialized care is not available elsewhere in Iowa, the Mayo Clinic will work with patients' MCOs to try to get prior authorization to continue care at Mayo Clinic, the organization said.

DHS spokeswoman Amy McCoy said about 5,800 Iowa Medicaid recipients were seen at the Mayo Clinics and Hospitals outside of Iowa last year.

"Mayo has said it will continue to work with the health plans on a case-by-case basis, called single-case agreements, which essentially are a per-patient contract," McCoy said. "This is how many arrangements are currently done with out-of-state providers who aren't enrolled with Iowa Medicaid's current network.

"Private market insurers also use these types of case-by-case agreements when a non-contract provider's services are needed."

The Mayo Clinic Health System also has physician services at Winneshiek Medical Center in Decorah, which McCoy said has signed a contract with AmeriHealth Caritas. The group provides primary and specialty care.

Kim Foltz, chief executive officer of UnitedHealthcare Community Plan of Iowa, told The Gazette on Friday that her MCO "has a good relationship with Mayo Clinic. I can't speak for them on this decision, ... but they have indicated they will work with us (on a case-by-case basis). We are interested in getting our members local services."

Foltz was in Davenport on Friday to celebrate the opening of a new 30,000-square-foot office housing its Iowa operations center. The 250 employees working at the building will staff the call center and claims operations, she said.

Foltz reiterated on Friday that UnitedHealthcare was ready for the originally scheduled Jan. 1 launch date, but noted the MCO has used this additional time for more trainings, internal reviews and audits.

"We've worked extensively to be prepared to answer questions and to be ready" for April 1, she said. "We will be overstaffed to answer the volume of calls coming in. It will almost be like a war room concept."

UnitedHealthcare has signed contracts with about 29,000 providers across the state, Foltz said, and it still is striving to improve its network.

"We're working with boarder providers as well," she said, "sometimes going two, three counties in to make sure we have the providers Iowans would be crossing boarders to see."

The DHS's McCoy said out-of-state providers often offer services one time through single-case agreements. There are about 22,500 out-of-state providers in the Medicaid fee-for-service network, she said, and the MCOs have signed a total of 23,900 contracts with out-of-state providers.

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