Aetna Better Health Promises Improvements for Kansas Medicaid Plan
Aetna Better Health has revamped its leadership team and is working to improve its administration of the Kansas Medicaid plan, KanCare.
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- Randy Hyun, the chief executive officer from Aetna Better Health, apologized at a public hearing in front of the KanCare oversight committee for Aetna Better Health’s mismanagement of the payer’s contract with KanCare, the state’s Medicaid program.
On Monday, the first day of the public hearing, providers and officials from KanCare came forward to recount stories of delayed reimbursements from Aetna, incorrect requests for payment, and unresponsiveness. The state’s list of contract compliance concerns elaborates further, including delayed credentialing, unapproved vendor contracts that Aetna agreed to and used.
KanCare explained that it needs to see Aetna resolve these issues to continue the contract. Otherwise, according to Adam Proffitt, director of Kansas Medicaid, Kansans will be forced to change health plans. Not only a $1 billion contract, but more importantly the healthcare access of 100,000 Kansans is at stake.
Hyun took full responsibility for the contract’s noncompliance.
“Clearly, the feedback we’ve received and some of the issues that have been brought to our attention and some of the issues we’ve seen internally have been extremely disappointing,” Hyun said. “I want to apologize for not living up to the expectations that I’ve had for our plan…We preach operational excellence and we certainly have not demonstrated that to you.”
Many of the providers and lawmakers expressed frustration and some were confused, due to Aetna’s long history in Medicaid.
“This isn’t their first rodeo in states that do managed care for Medicaid. So I don’t understand what their problems are,” Representative Brenda Landwehr (R-Wichita) said.
Aetna replaced Amerigroup as one of the state’s three Medicaid payers in June 2018. The contract was selected over six other payers’. Aetna covered medical benefits, long-term support services (LTSS), and behavioral health.
“We are known nationally for our ability to establish collaborative relationships with health care providers and community leaders that focus on making members healthier and improving their health care experience,” Janet Grant, Aetna Better Health’s regional vice president of the Great Plains, said at the time.
Her optimism was premature. A little over a year later, the state notified the company of Aetna’s failure to meet their standards.
When the Kansas Department of Health and Environment (KDHE) initially voiced its dissatisfaction and issued a notice of noncompliance, Aetna replied in nine business days with a corrective proposal. KDHE, however, rejected it.
“Quite frankly, we were not satisfied with the corrective-action plan that was given to us…We felt it lacked the necessary detail that showed they were going to get back into compliance,” Proffitt explained.
In response, Aetna overhauled its leadership. This included letting go of Aetna Better Health of Kansas’s chief executive officer, Keith Wisdom.
At the hearing, Hyun stated his certainty about these replacements and their ability to assist in the change effort. He also said that his team is drawing from the experience of Aetna experts nationwide to come up with solutions.
The state and Aetna are also working together to come up with a new plan that meets the state’s needs, the Wichita Eagle reported.
Unfortunately for Kansas, this is not the first time that the state’s Medicaid program has faced mismanagement issues with a private payer.
When Kansas privatized its Medicaid program in 2013, the state saw problems during the transition. Like Aetna Better Health’s noncompliance, the issues affected providers’ payments, which in turn can affect their ability to serve Medicaid beneficiaries.
And according to KCUR, Sunflower Health Plan and UnitedHealthcare have both received similar allegations to those that Aetna now faces.
There is no defined timeframe for the changes to occur. However, Proffitt and others expressed an expectation that Aetna should carry out its changes in a timely manner and they were unwilling to wait for years to see improvements.
Aetna also is encountering issues with its Aetna Better Health contract in Louisiana. Centene and Aetna are protesting Louisiana’s selection process in awarding Medicaid managed care contracts.
