Nevada Medicaid patients face loss of doctors

Thousands of Nevada Medicaid patients may soon have to find new doctors.

One of two managed care organizations that contract with the state to manage Medicaid patient care is about to lose a large network of primary care physicians and specialists.

HealthCare Partners of Nevada — a medical group consisting of more than 150 primary care physicians — confirmed that it will withdraw from Amerigroup Community Care on Nov. 30, according to Todd Lefkowitz, senior vice president of HealthCare Partners' managed care operations and network development.

HealthCare Partners said more than 12,000 patients on Medicaid will be affected, although Amerigroup has not confirmed that number.

Amerigroup and Health Plan of Nevada, which is owned by UnitedHealthcare, are the two managed care organizations that now contract with the state. They mostly provide services for low-income families and children.

HealthCare Partners said the decision to end its relationship with Amerigroup was made after "it became apparent Amerigroup had a different point-of-view on how to communicate with patients and how to maintain certain aspects of the relationship with them," according to David Tauchen, spokesman for DaVita HealthCare Partners, parent organization of the medical group. He declined to be more specific.

"We respect the insurance plans — both current and former — with whom we contract, so we prefer not to comment publicly on differences we may have with them," he said earlier this month. "Our focus is on providing the highest quality care and service to our patients and we made a decision that was in line with those priorities."

Under the contract between the state and Amerigroup, the managed care organization must maintain and monitor a network of providers sufficient to provide adequate access to all medical services under the contract, which includes primary care, dental services and urgent care.

Amerigroup indicates that it has a provider network that includes 13 hospitals, 640 primary care physicians, 2,098 specialists and more than 500 behavioral health providers in Clark and Washoe counties, according to a copy of the contract.

Amerigroup's contract with the state is not to exceed $1.5 billion. It expires June 30, 2017.

Amerigroup said it cannot speak on behalf of HealthCare Partners and its decision to terminate their relationship.

Amerigroup maintains that despite the terminated relationship, it still has a "robust primary care provider network in Clark County," according to Olga Gallardo, spokeswoman for Amerigroup. She did not answer questions about how many physicians and specialists it still has available to patients in Southern Nevada.

Patients affected by this change were recently notified by HealthCare Partners, Lefkowitz said.

Amerigroup said it's focused on ensuring a smooth transition for its members, Gallardo said. If members have questions, they can call the organization's national customer care department at 1-800-600-4441.

"We are taking proactive measures and have initiated communication to our members to ensure continuity of care as they transition providers," she said. "We continue serving Medicaid members in Clark County and don't anticipate this to impact the care of our members."

Open enrollment period for Nevada Medicaid beneficiaries to choose to stay with their current managed care organization or make a change started in early July and goes through Sept. 16, according to Chrystal Main, spokeswoman for the Nevada Department of Health and Human Services.

"The state monitors the provider ratio contract standards for Medicaid beneficiaries and meets with providers and stakeholders to address the issues surrounding the healthcare system," she said.

Contact Yesenia Amaro at yamaro@reviewjournal.com or 702-477-3843. Find her on Twitter:@YeseniaAmaro