It’s 43 feet long, contains three dental chairs and has been the setting for thousands of cavity fills, tooth extractions and checkups for low-income dentistry patients over the years.
The mobile dental clinic operated by Minneapolis-based UCare is perhaps the most tangible example, supporters say, of how the health plan has gone the extra mile to topple barriers to care for people with public health insurance coverage.
But now, the dental clinic, like the HMO itself, is traversing an uncertain path with the state’s decision to drop UCare as an option next year for most of the state’s Medicaid and MinnesotaCare programs.
“That’s the bulk of who we see in the mobile dental clinic,” said Dr. Paul Schulz, a faculty member at the University of Minnesota School of Dentistry, which jointly operates the unit. “I’m very concerned.”
To UCare supporters, the mobile dental unit is just one example of how UCare has stood out among health plans. Pointing to language services, transportation, and programs that target community needs, advocates say the HMO has led the way.
The prospect of forcing 369,000 UCare enrollees to switch to new health plans for next year is “outrageous,” said Alfred Babington-Johnson of Stairstep Foundation, a Minneapolis group that works to expand access to health care among black Minnesotans.
“More than the other entities in the marketplace, UCare has demonstrated a genuine concern for their low-income clients and has shown a willingness to enter health-oriented collaborations with communities of color,” Babington-Johnson wrote in an August letter to Gov. Mark Dayton.
In July, Dayton announced the results of a competitive bidding process that could save taxpayers $450 million, but will dramatically shake up the roster of HMOs and county-based groups that manage care in counties across the state.
Human Services Commissioner Lucinda Jesson said scoring for competitive bids was weighted more heavily toward the quality of services proposed by health plans, than the price for services. Specifics haven’t been released because the contracts haven’t been finalized, but Jesson said the new contracts will deliver better value for enrollees at a better price for taxpayers.
In selecting winners, state officials say they evaluated whether health plans could connect with diverse patient population groups and those with language barriers.
All health plans in the public programs are required to offer the same services, although there can be differences in how they do so. To the extent UCare had unique programs that worked, state officials will push HMOs to find ways to realize those same good outcomes, said Nathan Moracco, an assistant commissioner in the state Department of Human Services (DHS).
The department has convened an advisory group to flag potential problems. On the specific example of dental services, Minnetonka-based Medica — an HMO that stands to attract some of UCare’s lost membership — is now supporting a mobile dental clinic, too.
“We are as concerned as the communities about the transition itself, and that’s why we have put in place mechanisms for us to have these kinds of conversations, to do the crosswalks between what UCare was doing in the communities and what the other plans are doing — and how they plan to fill some of those gaps,” Moracco said. “We have the expectation that they will match the outcomes that UCare has been able to achieve, and we want to work with them on, sort of, how do we get there.”
Contracts for the state’s public health insurance programs are a big business for most health plans in the state, but especially UCare.
Medicaid covers people at or below the poverty level while MinnesotaCare insures a slightly higher income group. Together, the programs accounted for about half of the UCare’s $3 billion in revenue during 2014.
UCare will continue to operate a large health plan for Medicare beneficiaries, but the loss of the state contract likely would force hundreds of job cuts — possibly half of its 900-person workforce.
On Friday, UCare asked a Ramsey County judge for a temporary injunction to block the state from moving forward with changes. Several counties that jointly administer the Medicaid program are asking the state government to reconsider its decision. The judge said he would issue a ruling by Friday, Sept. 4, while decisions on county appeals are expected by mid-September.
The Dayton administration began its move to competitive bidding after imposing a 1 percent cap on HMO profits in 2011 due to concern that health plans were making too much money on the business.
There’s still plenty of profit margin remaining — too much, in fact, argues Allan Baumgarten, an independent health finance analyst in St. Louis Park. HMOs and county-based purchasing organizations in the programs collectively earned $146.2 million last year, Baumgarten said, for a margin of about 4 percent.
“Minnesota’s payments rates for those two programs are too high,” Baumgarten wrote in an e-mail.
In a court filing last week urging a Ramsey County judge to let the bidding results stand, Minnetonka-based Medica estimated it could gain 110,000 members from the new state contracts.
Medica has a 30-year history of working in the public programs, and was the largest Medicaid and MinnesotaCare health plan before competitive bidding. At that point, UCare was the third-largest plan in the programs, said Geoff Bartsh, a Medica vice president.
Medica led the way years ago in hiring call center representatives specifically to work with non-English speaking residents, Bartsh said. The company also touts the interpretive and transportation services it provides enrollees in public programs.
“If we’re expanding into new territories, if we’re working with populations who we haven’t worked with for a few years, certainly we’ll be doing additional outreach to them to either rebuild or create the relationships that we need to to effectively serve our members,” Bartsh said.
Like Medica, HealthPartners opposed UCare’s legal bid. The Bloomington-based HMO argued that UCare is not alone with its focus on diversity.
HealthPartners provides interpreter services in over 200 languages, the insurer said, and already is one of the largest providers of dental care to Medicaid patients in Minnesota.
Blue Plus, which is the HMO division of Eagan-based Blue Cross and Blue Shield of Minnesota, made similar arguments in a separate court filing.
The new contracts are being cheered in Hennepin County, where government officials expect more people will enroll in innovative care management program called Hennepin Health.
But groups raising concerns range from several Somali organizations and the chief executive of Allina Health System.
Advocates for Karen refugees in Ramsey County say they don’t have a lot of experience with other health plans because so many in the community are covered by UCare.
It’s possible other health plans will learn how to help refugees as well as UCare does, but the thought of going through the process just seems exhausting, said Alison Beckman, a project manager for the Center for Victims of Torture.
“When you come to this country, you don’t speak the language, there are all these layers of bureaucracy … and there’s a company that has proactively responded to these needs and made it easier for folks to access these services — it’s just made things so much easier for refugees,” Beckman said of UCare. “We don’t have to fight to get these things in place … they’re just already there.”
Many patients in the Karen community get primary care at the HealthEast Roselawn Clinic in Maplewood, where interpreter Paw Wah Toe often helps arrange transportation for refugees who need care.
“They see the situation, and they are willing to help,” she said of UCare. “They have heart.”