Taking the Bad with the Good

I thought it might be nice to talk about taking the bad with the good. First–both sides of the Iowa Medicaid Modernization issue. While my post from yesterday expressed my deep concern about where Iowa Medicaid is going, I did get a reply to my question about WellCare. It’s pretty much like the short answer I got during the Forum, but the long answer has more of a heart:

Dear Dr. Amos,

I was asked to respond to your questions and concerns.  University of Iowa Health Care’s core principle as part of its mission is that we ensure that all Iowans continue to have access to our care and services.  While we recognize that there are and will be a number of challenges and issues to work through, including a number of legal actions and appeals pending, Wellcare is still one of the four MCO carriers with over 100,000 Iowan’s tentatively assigned to coverage from that plan. 

If we are to provide access to the Medicaid members enrolled in WellCare, we will need to be contracted in their network.  That situation may change, and if so, we will adjust accordingly.

Thank you very much for raising your concern.  We continue to monitor events daily and adjust as needed to meet the needs of Iowans.

While this answer may not seem to say much more than “we need to cover everyone,” the person who wrote it put more feeling into it and acknowledged how difficult it is sometimes to take the bad with the good. After all, I doubt the University of Iowa Hospitals and Clinics had much choice in the matter. I’m sure they knew what they were getting into and it probably did hurt.

Moreover, University of Iowa Health Care has signed three (including WellCare) of the four Managed Care Organization (MCO) contracts and are working to have all four signed by the end of this week or early next week. Patients who have questions can contact the Iowa Medicaid Enterprise (IME) directly by email, IMEMemberServices@dhs.state.ia.us or call 1-800-338-8366, 8 AM–5 PM, Monday–Friday. The MCO choices:

Member Services Phone Nos.

  • Amerigroup Iowa, Inc.                                                       1-800-600-4441
  • AmeriHealth Caritas Iowa, Inc.                                       1-855-332-2440
  • UnitedHealthcare Plan of the River Valley, Inc.          1-800-464-9484
  • WellCare of Iowa, Inc.                                                       1-855-599-3811

Be advised, that phone number to IME has been getting 8,000 calls a day…I’m just sayin’.

In other news, the Clozapine REMS Program continues to struggle…and so do I. Based on my latest encounter, I think it might be easier for Psychosomatic Medicine specialists to think twice before re-enrolling medically hospitalized patients in the program who are on a stable clozapine regimen. What can happen, apparently, is that program representatives can advise temporary prescribers (general hospital psychiatric consultants like me, for example) who will continue clozapine while the patient is temporarily hospitalized on a general med-surg or ICU floor that they should not re-enroll him. This is because the primary prescriber has already previously enrolled the patient, is responsible for his care and wants to keep it that way.

I suspect that’s partly because if the consulting psychiatrist re-enrolls the patient under his or her name–that patient will remain on the consultant’s list and all Alerts will go to the consultant instead of the primary prescriber. And that, in turn, is because prescribers are avoiding certifying, in part, because of the troubled history of the Clozapine REMS Program.

Trust me, I know something about this.

But the Clozapine REMS Program still wants Absolute Neutrophil Count values. The only way to do that on the website is to enroll or re-enroll the patient–which we’re being told not to do so far, probably by those who have heard from frustrated prescribers who have already been burned by the dysfunctional website. The alternative is to fax the value (the form is at https://www.clozapinerems.com/CpmgClozapineUI/hcpHome.u to 844-404-8876 or call the program, 844-267-8678. I’m told that hold times are much shorter.

So while there may eventually be advantages to the centralized registry, the system still has a lot of bugs in it. I guess we have to take the bad with the good.