Three private companies are taking their fight to participate in Louisiana’s new health-care delivery system for the poor to the next level.
Aetna Better Health, Coventry Health Care of Louisiana and Louisiana Physicians Connections have filed protests with state Commissioner of Administration Paul Rainwater over their failure to get some of the business.
Rainwater has 10 days to respond.
In its protest, Aetna claims the awards should be thrown out because the state health agency did not use the proper procedure to solicit proposals.
Coventry questions the financial assumptions made in some of the winning proposals, suggesting that an independent actuary look at the numbers.
The move comes in the wake of state Department of Health and Hospitals Secretary Bruce Greenstein’s rejection of their appeals at the agency level.
“The secretary made the decision he believes is correct. Now it’s time for them to exercise their rights under the statute,” DHH Undersecretary Jerry Phillips said Tuesday.
“It’s part of the process,” he said.
The three firms were among a dozen private entities that wanted to run coordinated-care networks that would take over $2.2 billion of the state’s $6.7 billion Medicaid program.
Two-thirds of the state’s 1.2 million Medicaid recipients would be covered.
Five companies were tapped to participate in the Jindal administration’s venture into privatization of Medicaid service delivery. Contract negotiations cannot begin with them until protests are resolved.
The administration plans on rolling out the program beginning in January 2012. “We are on a time-line to make it happen,” Phillips said.
In their appeals, each company complains about inconsistencies in scoring that hurt them while benefiting those awarded the contracts and provide examples they said bolster their claims.
Aetna and Coventry also said key details of the winning proposals are being kept private, which denies them and the public the legal right to determine if good decisions were made.
“It is in everyone’s best interest to have a completely transparent procurement process,” according to a statement issued by Aetna.
Lack of access to public records related to the Medicaid bids, as well as additional scoring inconsistencies “require a more thorough review of the solicitation process by those responsible for this important program,” the statement continued.
Louisiana Physicians Connections, a Baton Rouge-based, minority-owned, physician-led organization, said it was unfairly penalized because it is a newly formed entity. Officials sought new scoring of its proposal.
Under the coordinated-care system, insurers, or private entities would form networks of physicians, specialists, clinics and other providers of health care.
The emphasis would be on preventive and primary care. The anticipation is that care coordination will reduce costs and lead to healthier people.
Louisiana Healthcare Connections Inc., Amerihealth Mercy of Louisiana Inc., and AmeriGroup Louisiana beat out Aetna and Coventry for one type of network plan.
United Healthcare of Louisiana Inc. and Community Health Solutions of America Inc. outscored Louisiana Physician Connections for the other type of network plan to be offered.