Executives of state contractor Aetna Better Health appeared Tuesday to have nudged the company away from a political lava flow that erupted three months ago amid evidence of failure to abide by a $1 billion contract to serve disabled, elderly and other people on Medicaid.
Randy Hyun, senior vice president for Aetna Medicaid, returned to the Capitol to affirm for a House-Senate oversight committee the Hartford, Conn., company was dedicated to upgrading its health care provider network, resolving credential backlogs for health professionals, limiting miscues in data tracking and to making accurate, prompt payment for services. The reception for Hyun was less adverse than when he issued a blanket apology in August for Aetna's shoddy performance and poor response when called out.
"Extremely proud of the progress we've made," Hyun said. "The work is not done yet, but we've come a long way."
Influential Republican House and Senate health committee chairmen and officials of the Kansas Department of Health and Environment in the administration of Democratic Gov. Laura Kelly expressed optimism Aetna was on the right path to remaining one of the three for-profit insurance companies employed by the state to serve 400,000 Kansans under the $3 billion Medicaid program.
Rep. Brenda Landwehr, a Wichita Republican and chairwoman of the House Health and Human Services Committee, said the managed-care companies were experiencing challenges known to have existed when the state administered Medicaid. She also said the MCOs should be more nimble in responding to shortcomings than the government.
"They couldn't have brought any more power any faster than what they did. Are they perfect? Nope, not yet," Landwehr said.
In July, KDHE sent a notice of contractual noncompliance to Aetna. The company's initial plan to correct inadequacies filed in early August was rejected by KDHE because it didn't sufficiently respond to chronic complaints of service providers and people enrolled in the system. Aetna jettisoned top personnel in Kansas and gained approval for a revised corrective action plan.
"We are encouraged with the comments from the department on the work you have done. Thank you for that," said Sen. Gene Suellentrop, a Wichita Republican who chairs the Senate Public Health and Welfare Committee.
In 2013, GOP Gov. Sam Brownback privatized Medicaid in Kansas and renamed the system KanCare. The state hired three companies to take over operational control of the statewide network.
Kansas UnitedHealthcare and Sunflower Health Plan, which also grappled with management problems, remain under contract with the state. In 2018, Amerigroup was ousted by then-Gov. Jeff Colyer. Aetna was selected as the replacement and began providing services in January.
While Aetna celebrated improvement in Kansans, the legislative committee heard from disability advocates, medical providers and others that Aetna continued to have difficulty with fundamental business operations.
Mike Moore, director of managed care and payer relations at Ascension Via Christi in Wichita, said Aetna fumbled around with claim payments, credentialing of providers and obtaining authorizations for Ascension's seven hospitals, 150 family practice physicians and 40 specialty providers across the state.
"Almost all of our claims have been paid incorrectly with Aetna Better Health," Moore said, "and when past claims are finally corrected, the issue itself is often not fixed, causing later claims to continue paying incorrectly. This creates a crippling amount of rework for both parties."
Aetna demonstrated "incompetence" in working with providers and had yet to conquer communication deficits that add to administrative burdens, said Paula Pedersen, director of patient financial services at Memorial Hospital and Heartland Healthcare Clinic in Abilene.
Tish Hollingsworth, vice president of reimbursement with the Kansas Hospital Association, said some improvement had been noted since Aetna admitted in August it was laboring under expectations of the MCO contract.
"We can say that we have seen some relief," she said. "However, we remain concerned with the multitude of issues that our members continue to report to us."
She said that 11 months into Aetna's transition into KanCare, hospitals in Kansas were being asked to close their annual budget books with many unresolved claims issues, including overpayment and underpayment.
"We know that many of our Kansas hospitals are frustrated with the amount of time their staff has spent on ABH issues," Hollingsworth said. "Not only because of the administrative burden in reprocessing claims, but also a financial burden for holding accounts receivable on a program that already pays less than our costs to provide."