TennCare Says MCOs Have Enough Providers in Region's Network

Reprinted from the April 5, 2007, issue of MEDICARE ADVANTAGE NEWS, biweekly news and analysis on the Medicare (and Medicaid) managed care programs.

A local consumer advocacy organization recently raised the alarm that the managed care organizations (MCOs) picked to serve TennCare's beneficiaries in the Middle Region of the state do not have enough providers and hospitals in their networks, but the state stands by the companies.

The two MCOs, AMERIGROUP Corp. and AmeriChoice (a UnitedHealth Group subsidiary), have "questionable provider networks," the Tennessee Health Care Campaign (THCC) said on its Web site March 25. The 340,000 beneficiaries in the Middle Region were being served before this month by BlueCross BlueShield of Tennessee, which operates TennCare Select - the state's backup health plan for continuity of care if other MCOs fail. The enrollees then had their choice of Blues providers, but "the new plans will provide less than half the doctors and very few hospitals," THCC claims.

The two MCOs began services in the Middle Region (including Nashville) on April 2 after winning contracts last July. It was the state's first competitive-bidding process, and the MCOs assumed full risk.

"Both plans have contracts with doctors and hospitals in the region that exceed the U.S. government's standards for operations," says a March 30 TennCare prepared statement. TennCare Select had about 4,000 providers in its network, according to that MCO.

Kent Jenkins, spokesman for AMERIGROUP, says he "strongly disagrees" with the assertion that its network is questionable. "We feel that we have built a robust network that is going to serve our members," he tells MAN. "As is always the case when you're starting an endeavor of this size, [providers] will come in late. There are some still coming in," he contends. Jenkins says the company has contracts with 35 hospitals in the region, including all the major Nashville hospitals, and has about 2,100 providers in its network.

Steve Matthews, spokesman for AmeriChoice, says the MCO wrapped up contract negotiations with two major Nashville hospitals at the end of March. With those, he says, the MCO has more than 40 hospitals in its network and "in excess of" 4,000 providers of all kinds, including 3,000 physicians.

TennCare is giving beneficiaries 90 days to transition from their old providers to one in their plan's network.

Tony Garr, executive director of THCC, told MAN on April 2 that he has not seen updated network data, and that he still does not believe the MCOs have enough providers to serve the beneficiaries. "I've only seen the provider books made available to the public, and they look very skimpy," he says.

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