TennCare Will Monitor New MCOs

The Tenncare Bureau plans to keep a close eye on new managed care organizations in Middle Tennessee.

At a meeting of the legislature’s Tenncare oversight committee (today/yesterday), Tenncare officials detailed the plans for new managed care contracts with United Healthcare and AmeriGroup. The two organizations will manage the health care benefits of 340-thousand midstate enrollees, starting April 1.

The state will pay the MCOs a set monthly amount per patient. The companies will take full financial risk, and it will be their responsibility to negotiate prices and develop an adequate network of participating doctors and hospitals.

Tenncare Networks Chief Winnie Toler says the state will resist the temptation to sit back and trust that the MCOs will maintain a balance between the money coming in from the state and the amount they owe providers.

“We have certainly made a commitment as the bureau, or as the state agency, to do our part in ensuring that these plans are ready to do business. We’re not going to go to sleep, as their switch goes on, our switch stays on. You know, our lights are still on to make sure that appropriate things are happening in the market.”

Initially, all Tenncare MCO’s were at full financial risk. But in 2002, the state assumed risk as mismanaged MCOs began to fall apart.

Later this month, the state will begin a readiness review of the two companies. At least 60 days before the MCOs take over, enrollees will find out which company they’re assigned to and be given a chance to switch.

Blue Cross/Blue Shield will continue to manage benefits for children who receive social security insurance and kids in the state’s custody.