State-contracted insurers say they're recruiting to fill provider gaps

Oct. 1—New Mexico may be making some progress in recruiting health providers to fix its sizable shortage of care — but, according to one industry leader's telling, every worker still counts.

Liz Lacouture, Presbyterian Health Plan's vice president of population health and quality, told state lawmakers recently about a New Mexico pediatric surgeon who expressed a desire to receive advanced training not available in the state — the insurance company sprang into action to keep the provider from decamping permanently.

"In order to keep that provider practicing in the state of New Mexico, we worked with Rady Children's Hospital in California to facilitate advanced surgical training through single-case agreements and assistance through out-of-state enrollment," Lacouture told members of the Legislative Finance Committee in a meeting Sept. 19, adding the doctor in question got the training and stayed in the state.

"Had that surgeon left New Mexico, more than 1,000 children would have had to have gone out of state for surgical procedures," Lacouture said.

Presbyterian Health Plan and the other three private health insurance companies contracted by state government to manage Medicaid benefits for most enrollees are under the gun to help recruit providers and expand health care access.

It's a major lift for New Mexico, which has struggled for years to keep practitioners in the state, especially in rural communities. Santa Fe-based think tank Think New Mexico, which recently released a report advocating for a slew of reforms to help fix the shortages, reported the state will have a shortage of 1,380 physicians by 2034, along with a shortage of 5,140 nurses, if current trends persist.

Lacouture and leaders of New Mexico's other three state-contracted "managed care organizations" told lawmakers during the meeting they're all searching for ways to make care more accessible.

"We're determined to bring innovative solutions forward that can make a sustained impact on addressing provider shortages," Lacouture said.

Andrew Peterson, CEO of UnitedHealthcare Community Plan of New Mexico, said his company has recently recruited providers to staff school-based programs in Grants and Bloomfield; a new mobile health care initiative for rural communities; and a new in-person and telehealth service focused on maternity and primary care.

Nancy Smith-Leslie, vice president of Medicaid for Blue Cross and Blue Shield of New Mexico, said the company has "significantly increased" the number of behavioral health facilities, providers and virtual clinicians in its network. Blue Cross and Blue Shield added 230 new behavioral health contracts in 2023 and has added 174 so far this year, she said.

In the weeks to come, Smith-Leslie said the company is also poised to announce a new investment aimed at improving maternal health through a few different projects. One initiative will support a statewide maternal data program for birthing facilities to track outcomes and safety for New Mexico moms. Another involves expanded behavioral health services for pregnant mothers.

Several of the managed care organizations said they are financially supporting the New Mexico Doula Association and consider the training of new doulas — who support pregnant women before and during labor but are not medical providers — as an aide, particularly in "maternity deserts" where no obstetric providers are available.

Carolyn Ingram, plan president for Molina Healthcare of New Mexico, said her organization has recruited new providers to staff Molina Care Connections, a new behavioral health program that offers home visits, particularly for high-risk participants who need immunizations or other treatment.

Lacouture said some health care practitioners are hesitant to become Medicaid providers — but in the case of Presbyterian Health Plan, the insurer doesn't offer an opt-out.

"A condition for Presbyterian's network is that providers who want to contract for other lines of business, like commercial and Medicare, also have to agree to a Medicaid contract," she said. "This ensures equity for our members and adequate access for New Mexicans."

Ingram asked lawmakers to consider joining interstate compacts for counseling and psychology, which would allow providers from select other states to offer services in New Mexico — a process Rep. Gail Armstrong, R-Magdalena, said is already in the works.

Legislative Finance Committee Chair George Muñoz, a Democratic Senator from Gallup, said the compacts have been coming up repeatedly in recent days.

"I think that's going to be a key issue moving forward, so keep pushing that," he said.

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