1) HomeTown has conducted 6 policymaker trips to member hospitals this year of 2016 the last of which was last week with Care Source CMO. See attached travel schedule for hospitals visited.
  1. a. Care Source attendees included
i. Bobby Jones – President Georgia Care Source
ii. Jason Bearden – V.P. Market Operations – from Georgia
iii. Darren Morgan – V.P. Health Partner Services
iv. Jason Anavitarte – Director State Development and Advocacy – from Georgia
v. Along with Jimmy Lewis HTH and Sandy Sage HTH
  1. b. Participating Hospitals included
i. Upson Regional
ii. Warm Springs Medical Center
iii. Tanner Villa Rica
2) Georgia is implementing its fourth CMO in 2017, Care Source
3) The fourth CMO will be a not for profit named Care Source from Ohio
4) Care source by state decisions will be allocated 200,000 covered lives of the current 1,300, 000 Medicaid Patients under CMO management
5) Implementation will occur July 1, 2017
6) It was a very candid and forthcoming visit at all hospitals. Care Source as with the other CMO’s has a great team to work with
7) Care Source will be implementing two new CMO plans at the same time as in Georgia and Indiana
8) The Care Source network for Georgia has to be completed in the next few weeks to qualify as a Georgia CMO
  1. a. Rural providers will be pursued aggressively by Care Source to get contracts agreed upon
9) The complete Care Source implementation team has to be hired and trained as field representatives in these first six months of 2017, for example, among other titles

Whatwehear: (whatwehear is just that- whatwehear from underthegold

dome - from good sources but not final until announced)
1) The 200,000 patient allocation algorithm has not yet been finalized
2) Currently the 1,300,000 covered lives are distributed over 3 CMO’s
  1. a. The proposed method to redistribute is heard to be
i. Conduct a full open reenrollment of 1,300,000 patients in or about the first quarter from 3 CMO’s to 4 CMO’s to include Care Source
ii. Upon completion of the reenrollment, the tallies will be made as to how many patients end up in each CMO whereupon an algorithm will be developed to auto assign patients to Care Source to achieve the 200,000 patients to be allocated
  1. 1. That algorithm is currently not known
iii. There are many questions to be answered about this reallocation such as
  1. 1. Are there any requirements for patient totals for old CMO’s
  2. 2. What if current CMO’s have a major enrollment shift
  3. 3. What if the 200,000 Care Source allocation has counties, districts, or regions that have very few assigned patients
  4. 4. What if the predominance of the care Source Allocation goes to urban centers
  5. 5. What happens for pre-authorizations at changeover time who have been preauthorized for CMO but no fall to CMO B” for care or procedure
  6. 6. Will there be a $50 triage fee
  7. 7. What will be the denial frequency with a new 4th CMO
3) What can this mean to rural hospitals?
  1. a. It will mean the incorporation of a totally new 4th software platform and portal for business offices thus major new training required
  2. b. It will mean the enrollment of a lots of new or different patients into rural hospital systems
  3. c. It can mean the exponential increase of claims processing problems and issues for a while
  4. d. It will mean getting to know a new cadre of field representatives
  5. e. This can be occurring when rural hospitals are experiencing difficulties when patients with high deductibles who avoid coming to hospitals thus creating cash distressed hospital and physician positions for first six months of 2017
  6. f. This will be occurring at a time when the repeal and replacement of Obamacare is creating chaos and turmoil
4) What to do? Action required?
  1. a. Educate your team
i. Attend all HomeTown webinars and HomeTown Health University
  1. 1. Read an educate from all HomeTown Update Emails as we try to get the most current information to you.
ii. Attend all Care Source webinars and training and mail outs
iii. Be very aggressive in getting to know Care Source Field representatives – reach out to them. You snooze you lose.
  1. b. Attend HomeTown CEO Day Thursday February 9, 2017 for networking with other hospital CEO’s to see how well their transition to Care Source is going
  2. c. Forward any and all questions to HomeTown for research and publish to the HomeTown network
5) Send “ thank you’s” and ‘congratulations” to the teams at the three hospitals hosts, including
  1. a. Tripp Penn – CEO at Upson Regional
  2. b. Karen Daniel - Administrator at Warm Springs Medical Center
  3. c. Dr. Bonnie Boyles – CEO at Tanner Villa Rica

Once gain the value of HomeTown comes from the ability to conduct these visits and educate hospitals and policy makers about your concerns. Thank you for the privilege of serving your hospital in this manner.

Forward any and all questions on this conversion.