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Passport To Good Health
By Kevin Hyde
It was the beginning of a beautiful friendship—a collaboration among peers to create one of the best Medicaid programs in the country. In 1997 a group of historic safety net providers, including the University of Louisville Medical School Practice Association and University Hospital, established University Health Care Inc. (UHC).
Doing business as Passport Health Plan, it now provides a sole source, Medicaid-managed care plan serving more than 137,000 members in Louisville and 15 surrounding Kentucky counties. Less than a decade into its existence, Passport’s achievements keep mounting and its momentum keeps growing.
As other Medicaid programs around the state and country struggle, Passport thrives.
“It has demonstrated above all that management of Medicaid and the delivery of quality care with strong access are not incompatible,” says Dr. Larry Cook, U of L executive vice president for health affairs and Passport chairman of the board. One of the driving forces behind Passport’s creation, he cites it as one of the most rewarding accomplishments of his U of L career.
Cook says Passport’s success can be best seen in the “outstanding levels” of provider and member satisfaction. One member, who just wanted to be referred to as Anna, couldn’t agree more.
“Somebody cares about you and makes sure you’re OK …” she says. “I appreciate the fact that somebody is there … if you need some help or someone to talk to. Even just to talk, you can call them and talk to them.”
Another strong measure of success, according to Cook, has been Passport’s two consecutive highest-level certifications from the National Committee for Quality Assurance (NCQA), an independent, not-for-profit organization dedicated to measuring the quality of America’s health care. To receive NCQA’s “Excellent Accreditation,” a health plan must meet rigorous requirements for consumer protection and quality improvement.
When NCQA partnered with U.S. News and World Report last year on a national survey rating the top Medicaid programs in the country, Passport ranked #18 on the magazine’s list of “America’s Best Health Plans.” The rankings are based on clinical performance, member satisfaction and NCQA accreditation.
“We have worked hard to improve the health and quality of life for our members by offering innovative programs in disease management, pharmacy management, case management and member education,” Cook says. “Obviously, these programs are working.”
Passport offers members major medical, vision care, dental care and prescription medications. It also provides several health education and outreach programs targeted at special needs clients, prenatal care, diabetes and asthma management and a comprehensive pediatric screening program for members under 21.
“… [My case manager] talked me through a lot of things that I needed to know about diabetes and my sugar, and different things I needed to know about taking care of myself,” says Cheryl, another Passport member. “I have someone behind me to encourage me to keep going.”
Passport has also introduced innovative pilot projects addressing the problem of childhood obesity and a palliative care program—led by U of L faculty member Dr. Mark Pfeifer—with early interventions and hospice care for end-of-life issues.
When the Centers for Medicare and Medicaid Services (CMS) announced the extension of Passport’s federal waiver last October, CMS administrator Scott McClellan said Passport is “among the highest performing Medicaid managed-care demonstrations in the country.”
Passport has been operating as a demonstration project with goals of improving Medicaid patient access and care and controlling its rapid cost increases.
“It is especially gratifying to see documented improvements in access to health care by children and an overall improvement in health outcomes for all enrollees,” McClellan says.
Passport recently was featured in a new report, “Innovations in Medicaid Managed Care,” released by America’s Health Insurance Plans (AHIP) of Washington, D.C. The report lauded the plan for effectively achieving improvements in health care while offering taxpayer value to Kentucky citizens.
According to independent consultants, Passport has saved the state $191 million since its inception.
“Passport Health Plan has designed programs that work for Medicaid beneficiaries and also for Kentucky,” says Karen Ignagni, AHIP’s president and CEO.
The U of L Connection
The Medicaid population is important to the U of L Health Sciences Center's mission of teaching doctors, nurses and dentists to practice in a diverse community, Cooks says. While care of the underserved has traditionally been part of the university's mandate, the educational benefit is also important to U of L’s ability to produce well-rounded professionals who are sensitive to and have an understanding of challenges that low-income patients may experience that contribute to health disparities.
That’s why U of L, through its Medical School Practice Association (MSPA), put up 51 percent of the original funding for UHC, the licensed HMO that owns Passport. University Hospital put up another 13 percent. The vast majority of Passport providers in Louisville are affiliated with the university’s medical, dental or nursing schools.
“U of L is the majority owner of Passport/UHC and, as such, has had a unique ability to shape the direction of the organization,” says Jim Taylor, president of University Hospital and CEO of its parent organization, University Medical Center Inc.
But the U of L people who helped develop UHC and Passport—individuals including Cook; Robert Slaton, UHC executive vice president; Bill Wagner, executive director of the Family Health Center Inc. (the Kent School of Social Work 2006 Alumni Fellow); and Belinda Love of MSPA—credit the entire partnership for Passport’s success.
Partners like Jewish Hospital, Norton Healthcare, Federally Qualified Health Centers and the local Association of Primary Care Physicians teamed with U of L in the late 1990s to get Passport started.
“All of those founding organizations were, and still are, the safety net that takes care of most Medicaid and indigent patients in this area,” Slaton says. “We had this founding group that was really interested in the quality of care to the members.
“We didn’t do this to make money. Whatever happened, we wanted to make sure Medicaid was logical and coherent. Our goals were to try and hold down the growth in Medicaid cost and to essentially make future cost increases predictable and improve quality. Which we have done.”
The fact that U of L has a decentralized medical faculty—spread across three different hospital systems—aided the collaboration, Slaton adds.
“We couldn’t tell anybody what to do,” he says. “We had to bring them together and sell them. And by doing that, we got buy-in. Our partnership council has 30 members, but we have subcommittees that involve 150 other providers—lots of doctors, hospital administrators, nurses—all kinds of people.”
Slaton adds that contracting with AmeriHealth Mercy Health Plan of Philadelphia to administer the program was an important early step. AmeriHealth Mercy and its affiliates constitute the largest multi-state, Medicaid-managed care organization in the country, touching the lives of nearly 1 million Medicaid and State Children’s Health Insurance Program members in seven states.
“I think they’re quite simply the best at what they do in the country,” Slaton says.
Another reason for Passport’s success has been its members’ freedom of choice. They can select from more than 3,000 primary care providers in more than 220 locations.
“[Passport] has taken a managed-care approach to providing services,” Taylor says. “What that means is that providers are at risk for providing agreed-upon services to a defined population at a negotiated cost.
“Further, a provider-owned plan pays attention to the needs of those delivering services in ways that commercial managed-care plans don’t. From the commonwealth’s perspective, Passport has consistently delivered high client satisfaction with services, high ratings in quality of services and at a cost to the state well below non-Passport areas and below the U.S. medical inflation rate.”
Passport has brought the Medicaid population a “medical home” and the idea that it is important for members to participate in that home, Cook says.
“[We recognize] the financial benefits of treating people who are well and keeping them well,” he says.
