Medicaid Patients and Doctors Are Seeking a Cure for Denver Health's Managed Care

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Parmar's doggedness seems to have changed that. The 39-year-old doctor founded his practice, Ardas Family Medicine, in 2012. His mission to serve refugees stems from his own background: His parents emigrated from India to Canada and eventually to the United States, where Parmar grew up. Of his refugee patients, he says, "I can identify with them."

When it comes to Denver Health Medicaid, Parmar hasn't been willing to give up. He's written blog posts about the situation and hounded Gurule and the staff at Health Colorado, often e-mailing them about individual cases. He even left his wife at the hospital several hours after she gave birth to their son this past December and drove through a snowstorm to attend a focus group with the state and Denver Health. When six months went by and it seemed there were still no changes under way, Parmar started the petition and put it out on Facebook. And because he guessed that politics were at play, he also e-mailed it to Colorado's congressional delegation and every member of the state House and Senate health and human services committees.

Senator Aguilar was the only lawmaker who e-mailed him back. "I wrote back to him and I said, 'Why don't we meet with HCPF?'" Aguilar recalls. "He said, 'I've met with them, and they've never done anything for me.'" But Aguilar eventually convinced him to attend a sit-down, and that meeting seems to have lit a fire under state officials.

"We were aware of this issue beforehand," says HCPF's Karabatsos. "This petition just helped shine a light on the issue a little bit more and helped all of us move more quickly."

Aguilar's involvement probably didn't hurt, either. "I do think it's true that a legislator gets attention that the average provider can't get," says the lawmaker, who has been on both sides of it. For 23 years, she worked as a doctor at the Denver Health Westside Health Center. Even though this issue was going on while she was there, Aguilar says she was unaware of it.

"As a doctor for Denver Health, you're not as aware about how people's health care is paid for." Unlike a doctor with a private practice, she explains, Denver Health providers get a paycheck every two weeks regardless of who they see or whether those people pay.

Some of the comments on Parmar's petition are as follows:

-- "I am a family physician, a safety net provider in Englewood...I see a gentleman monthly to manage his multiple complicated medical problems. He lives in Denver, and when he applied for Medicaid, I instructed him to get 'regular' Medicaid, which he did. I continued to see him and billed Medicaid monthly. Then suddenly he had Denver Health Medicaid. He couldn't fill any of his prescriptions or get his monthly lab work done. When he called to get it fixed, they were eventually willing to switch him back (after he spent several hours on the phone and contacted me several times for assistance). However, they wouldn't make it active until the first of the next month. So he still couldn't get anything that he needed, and I was never paid for his appointment during the time they decided to switch him to Denver Health Medicaid."

-- "I, as a social worker, work with pregnant teens and their babies at Children's and University hospitals. We have many young ladies who come and develop a relationship with us, only to have their Medicaid switched to Denver Health right before they deliver or after they deliver, and they are required to go to Denver Health, but do not desire to do this. Supposedly, our young ladies can call to change their Denver Health Medicaid...but most of them have run into roadblocks and have talked to individuals on the phone who won't let them change."

-- "I moved here almost two years ago and quickly fell into a position that required getting my children and myself on Medicaid. I was not informed when I applied that there were two types of Medicaid, and I was just told that I had to go to a specific Denver Health facility.... I also had to wait about a month just to have my first appointment to see a doctor."

At the time that Parmar posted the petition, Karabatsos says, HCPF was already in talks with Denver Health about dismantling the passive-enrollment system. The idea is to move to a system that enrolls patients based on their provider history: If they're a Denver Health patient, they'll be enrolled in Denver Health's plan. But if they have a history with another provider, they'll be enrolled in a plan that allows them to continue to see that doctor.

It seems like common sense. But making it happen won't be simple. To get rid of passive enrollment, the state must also make changes to the computer system that pays doctors for providing services to Medicaid patients. The current system is both antiquated and complicated, and rather than modify it, the state is in the process of replacing it. The estimated cost to do so is $180 million. Officials expect the new system to be online by 2016.

"We're in the process of procuring a new computer system," Karabatsos says, "and it will take us a couple years to get that up and running." In the meantime, she says, the state is working with the vendor that runs its system to see if there's a quicker way to make the switch.

Denver Health officials acknowledge that there have been "some bumps in the road" with passive enrollment, and they say they're fine with getting rid of it for patients who have a history with a non-Denver Health doctor. "We're very supportive of that, because I think it's better service for the patient not to be disrupted," Donovan says.

Officials also say that Denver Health is willing to grant "authorizations" to outside doctors such as Parmar to get paid to see patients who show up unaware that they've been switched to Denver Health and who need to see a physician right then. However, some doctors report that they have difficulty getting those authorizations or can't get them at all.

Even without passive enrollment, Donovan and others are confident that Denver Health will continue to attract patients. Its plan offers several perks, she says, including free eyeglasses, a two-month supply of diapers for mothers who deliver at the hospital, and health coaches and case managers who help patients with complex medical conditions stay healthy.

As for the wait list to get an appointment, Denver Health officials say they're working on it. In 2013, the list had more than 10,000 adult patients on it. But over the past year, the organization has hired seventy new staff members in its primary-care clinics, says spokeswoman Kelli Christensen, including seven doctors, twelve nurses, eleven physician assistants and nurse practitioners, three dentists and seven behavioral-health specialists. Denver Health has also expanded the hours of its clinics and plans to break ground on a new clinic in southwest Denver this fall. Today the wait list has decreased to 5,500 patients. The median time to get an appointment has also dwindled from several months to less than thirty days, Christensen reports.

But those numbers don't necessarily apply to Denver Health Medicaid Choice members, officials say; Denver Health has always made the patients who belong to its own health plans a priority. As of July, the wait time for new Medicaid patients to get an appointment was less than eight days, Christensen says. The term "wait list," she insists, is a misnomer.

"I am just amazed at what we do for these patients," Donovan says.
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Melanie Asmar is a staff writer for Westword. She joined the paper in 2009 and has won awards for her stories about education, immigration and epic legal battles. Got a tip? She'd love to hear it.
Contact: Melanie Asmar