The state’s health-care chief denied the protests lodged by the companies losing contract bids to participate in the Jindal administration’s private insurance-based health-care system.
Aetna Better Health Inc., of Hartford, Conn., and Coventry Health Care of Louisiana, of Bethesda, Md., raised technical issues about the way the process — called Request for Proposals or RFPs — was operated by the state Department of Health and Hospitals.
DHH Secretary Bruce D. Greenstein countered that the 15 individual scorers were divided into five teams that evaluated specific sections of each proposal.
He wrote separate letters to the two bidders on Friday. The letters were released Monday.
The two companies were among the dozen private entities that wanted to run the “coordinated-care networks” poised take over $2.2 billion of the state’s $6.7 billion Medicaid program, which provides health care for the poor.
Moving away from the state’s traditional fee-for-service system, the Jindal administration argues that tax dollars can be saved by paying private insurance companies to handle health care for about 850,000 of the 1.2 million Louisiana residents on Medicaid.
The program begins in New Orleans, and communities on north shore of Lake Ponchartrain will go live in January. “Coordinated-care networks” will begin being set up in the Baton Rouge and Lafayette areas on Jan. 15.
Louisiana Healthcare Connections Inc., Amerihealth Mercy of Louisiana Inc. and AmeriGROUP Louisiana Inc. beat out the two firms for the business.
Both Aetna and Coventry complained about the scoring of several portions within the RFPs. For instance, Aetna argued that when assessing financial strength, the scorers did not properly look at the insurance company’s $17.5 billion unrestricted investments. Greenstein responded that Aetna failed to timely challenge that methodology. He also wrote Aetna’s lawyers that the points awarded by the evaluators met the criteria.
Coventry attorney Perry R. Staub Jr. wrote to Greenstein that, “the fairness of the proposal evaluation process appears to have been compromised.”
Staub detailed alleged scoring problems in four specific areas, including failing to do an independent assessment of whether Medicaid recipients would be getting “added value” in the services to be offered.
Greenstein agreed with several assessments Conventry’s lawyers made about how various programs were evaluated. But, he wrote, the submissions met the criteria and thus were scored correctly by the initial evaluators.