DETROIT, June 28 /PRNewswire/ -- Total Health Care, Inc., a Detroit-based Health Maintenance Organization, that has successfully served members for 30 years, said today it will appeal a decision of the Michigan Department of Management and Budget to not renew their Medicaid contract.
“Total Health Care has served members for 30 years and has served Medicaid recipients for 25 years without any disruption in service,” said Board Chair Francis Lynch. “We have served our customers effectively, paid our bills and stayed financially solvent, even as other HMOs became insolvent.”
“With that track record of fiscal responsibility, we are at a loss to understand the state saying that we are no longer fit to serve our members.”
Total Health Care Executive Director Lyle Algate said the decision by the Michigan Department of Management and Budget was based on a point system that includes several built-in assumptions that provide an advantage to larger out-of-state HMOs over Michigan-based HMOs.
“In a May 2004 meeting, state officials involved in the selection process said their goal was to force consolidation in the industry and eliminate smaller HMOs,” he said. “For the state to cut us out of the picture when we have succeeded while so many others have failed is wrong and a tremendous disservice to our members.”
Ruby Cole, a full time nurse who sits on the board of directors for Total Health Care, said she is particularly concerned about the disruption that could occur in service to Total Health Care’s members.
“Thousands of our members would be forced to find a new health care provider if they are forced into another system,” she said. “Some of these members are senior citizens and have been seeing the same physicians for over 20 years. That is very troubling to me as a nurse and Detroit citizen. The state is trying to eliminate a health care organization that has stood behind its citizens, always paid its bills and provides jobs to Detroiters.”
Algate said the state’s disqualification of Total Health Care is even more puzzling in light of the fact the system just received the highest accreditation possible from the Joint Commission for Accreditation of Health Care Organizations (JCAHO).
“In 2003, Total Health Care, at the direction of the State Department of Community Health, underwent a lengthy and costly accreditation evaluation by the Joint Commission,” he said. “The result was it awarded us the highest level of accreditation -- a full three-year accreditation. For a state agency to turn around a few months later and disqualify us from serving our Medicaid members makes absolutely no sense.
“The state’s criteria are an arbitrary set of standards including highly technical elements that work in favor of larger out-of-state plans. We believe that, as a successful locally based plan we can serve our members more personally, more effectively and more quickly than larger plans located in places like Maryland, Minnesota or California. We will do everything we can to assure that we are able to continue serving our members who rely on us for the best possible health care.”
Total Health Care’s proposal to the state included endorsements from Detroit Medical Center President and CEO Michael Duggan, Hurley Medical Center President and CEO Julius Spears, Jr., and St. John Health System Vice President for Managed Care William D. Isenstein.
“Your process should give full consideration to longevity, provider relationships and financial stability,” Duggan said in his letter. “It is for these reasons that Total Health Care is our first choice of Medicaid health plans.”
Lynch said that while Total Health Care appeals the decision, it will continue to pay its providers and provide excellent service for its members.
Total Health Care, Inc., a Michigan licensed and federally qualified managed care organization, was founded and incorporated as a non-profit corporation in 1973 and is the second oldest HMO in Michigan. Total Health Care serves 58,000 members, including 48,000 Medicaid recipients, and offers a comprehensive health care delivery network that includes over 250 health care centers and more than 1,000 primary care and specialist physicians in the counties of Wayne, Oakland, Macomb and Genesee.
Total Health Care holds full accreditation status with two nationally recognized accrediting organizations, the Joint Commission for Accreditation of Health Care Organizations (JCAHO) and the Accreditation Association for Ambulatory Health Care (AAAHC).
TOTAL HEALTH CARE Questions and Answers Q. What is Total Health Care and who is their customer base?
A. Total Health Care, Inc. is a Michigan licensed and federally qualified Health Maintenance Organization (HMO) that has been in the community for thirty years. Total Health Care serves more than 58,000 members and offers a comprehensive health care delivery network that includes more than 250 health care centers and more than 1,000 primary care physicians and specialists in the counties of Wayne, Oakland, Macomb and Genesee. It participates with medical systems including the Detroit Medical Center, St. John Health, Providence, Hurley and Oakwood health systems.
Q. Is Total Health Care financially sound?
A. Yes. Total Health Care has been solvent for the past 20 years. Total Health Care has always paid its providers for services and has always met its financial responsibilities.
Q. Why has Total Health Care remained financially strong when other HMOs went under?
A. Total Health Care has at all times remained diligent in controlling its costs while assuring that its members receive quality health care. Cost effective health care is our goal. As a result, we have always stressed preventive medicine, education of our members and outreach to chronically ill members with home visits by nurses to assure these members receive ongoing attention to their condition.
Q. Has Total Health Care ever had trouble paying their bills?
A. No. As a result Total Health Care has excellent relationships with its providers.
Q. Is Total Health Care accredited?
A. Total Health Care holds full accreditation status with not one, but two nationally recognized accrediting organizations. In 2002 its accreditation was renewed by the Accreditation Association for Ambulatory Health Care (AAAHC) for the maximum allowable three years. Then, in 2003 Total Health Care, at the direction of the State Department of Community Health, underwent a lengthy evaluation process with The Joint Commission for Accreditation of Health Care Organizations (JCAHO). The Joint Commission awarded its highest level of accreditation -- a three-year accreditation.
Q. If Total Health Care has always been a financially stable entity and if it is fully accredited by two respected national accreditation agencies, how did it end up out of the running?
A. The new state criteria include several built-in assumptions that provide an advantage to larger out-of-state HMOs over Michigan-based HMOs. In a May 2004 meeting, state officials involved in the selection process said their goal was to force consolidation in the industry and eliminate smaller HMOs.
Q. Does that mean that the state’s criteria are not necessarily an accurate gauge of an HMO’s financial health or service to its members?
A. We believe so. The state’s criteria are an arbitrary set of standards including highly technical elements that work in favor of larger out-of-state plans. We believe that, as a successful, locally based plan we can serve our members more personally, more effectively and more quickly than larger plans located in places like Maryland, Minnesota or California.
Q. How does Total Health Care’s record of grievances compare to other HMOs?
A. The State of Michigan Department of Community Health HMO Complaint data for 2002 shows Total Health Care having one of the lowest rates of complaints from members of any HMO in the state. Total Health Care averaged less than one complaint per one thousand members, .7 complaint per 1,000 to be exact. Some other HMOs the state has included in its approved list had much higher rates. For example, Midwest Health Plan, Inc. had 31.7 complaints per 1,000 and Molina Healthcare had 11.9 complaints per 1,000.
Q. How many persons does Total Health Care employ?
A. Total Health Care employs 55 persons, all of them in its Detroit headquarters.
Q. Are any of the vendors that were awarded contracts Detroit-based? A. None of the vendors are Detroit-based.
Q. What will happen to those Medicaid members that are already covered by Total Health Care if the contract is not renewed?
A. Those members will not lose health care coverage but their lives could be disrupted. For example, they may not be able to see the same physician that they have been seeing. Some of Total Health Care’s members have been seeing the same physician for over 20 years. Thousands of patients will have to be shifted to new physicians.
Q. Can Total Health Care appeal the decision and in the meantime will it continue to pay its providers?
A. Yes, Total Health Care can appeal and is in the process of doing so. It will continue to pay its providers and provide excellent service for its members.
Q. What can the public do to voice their support for Total Health Care?
A. The public can write letters in support of Total Health Care and mail the letters to the Governor’s Office or to Total Health Care to be forwarded to the Governor. The letter of support should be addressed to Gov. Jennifer Granholm.
Q. Who owns Total Health Care?
A. Total Health Care is not-for-profit which means its 58,000 members own it.
Q. What do your health system partners say about Total Health Care?
A. Following are direct quotes from letters sent by our providers to the State of Michigan in support of our application:
“Total Health Care is our first choice of Medicaid Health Plans. We strongly encourage you to weigh all of these factors in the final selection of plans and that Total health Care continue as our plan of choice in Wayne, Oakland and Macomb Counties. Their continued participation is vital to our partnership of service to the community.”
Michael Duggan, President and CEO Detroit Medical Center
“For over 15 years we have enjoyed a very positive relationship with Total Health Care, Inc. Total Health Care has always dealt with St. John Health in a fair and equitable manner and routinely pays their claims in a timely manner. It is because of this longstanding positive relationship that Total Health Care is one of our preferred southeast Michigan Medicaid Health Plans with whom to conduct business. We are asking that your process give full consideration to longevity, provider relationships and member disruption and therefore ask that you award Total Health Care a contract in the upcoming process.
William D. Isenstein, Vice President of Managed Care St. John Health
“Total Health Care demonstrates a concern for the health outcomes of the population they serve. This year, Total Health Care has partnered with the Hurley PHO through a physician-incentive program to participate in the Clinical Performance Target initiative to address quality of care issues in disease management. Total Health Care consistently supports projects in our hospital community through the Hurley Foundation and Children’s Miracle Network.
“We strongly encourage you to weigh all of these factors in the final selection of Plans and that Total Health Care continue as our Plan of choice in Genesee County. Their continued participation is vital to our partnership of service to the community.”
Julius D. Spears, Jr., President and CEO Hurley Medical Center
“Your process should give full consideration to longevity, providers’ relationships and potential enrollee disruption. We do not want to change from a plan that has insured access to care and has proven that it is committed to the community to one that is unknown. Let us keep the Plan that is familiar to my patients so that we all might avoid the disruption that comes with a new unknown alternative.
“It is for these reasons that Total health Care is our first choice of Medicaid Health Plans. We strongly encourage you to weigh all of these factors in the final selection of Plans and that total Health Care continue as our Plan of choice in the City of Detroit. Their continued participation is vital to the continuity of care to the community.”
Dr. Claud R. Young, D.O. President, Michigan Chapter National Chairman of the Board Southern Christian Leadership Conference
Total Health Care, Inc.
CONTACT: Bob Berg of Berg Muirhead and Associates, +1-313-872-2202, forTotal Health Care, Inc.
