If you had any doubt that the American health care system is broken, consider what happened with Greater New Bedford’s largest health care provider this year.
As of Jan. 1, Southcoast Health stopped accepting patients who use Senior Whole Health as their Medicare and Medicaid insurer.
Senior Whole Health, a subsidiary of the Fortune 500 company Molina Healthcare, had insured hundreds of city residents — senior citizens and the disabled — for many years. When Southcoast ended its relationship with the company, it meant that subscribers to Senior Whole Health could no longer see their Southcoast primary care doctors or any specialists who followed them, nor could the Senior Whole Health clients be admitted to any of Southcoast’s three area hospitals — St. Luke’s in New Bedford, Charlton in Fall River and Tobey in Wareham.
Senior Whole Health subscribers who showed up at one of the Southcoast hospital emergency rooms would still be treated, but on an out-patient basis for the course of that visit.
“It wasn’t just an inconvenience, it was a hardship,” said Justin Lees, chief executive officer of Coastline Elderly Services.
For many elderly patients who have long seen the same doctor for years, it was disconcerting having to suddenly find a new doctor.
“You develop a comfort level with your primary care physician,” Lees said.
Lees later wrote in a text that he “double checked internally,” and that he does “not have any record of someone who was unable to find treatment when needed.” He also wrote that “From what we know, most that have switched plans away from Senior Whole Health have been able to find a PCP.”
Coastline, according to its website, is a nonprofit corporation that provides home care services designed to allow its clients to live independently.
Lees estimated that Coastline had about 2,000 clients who subscribed to Senior Whole Health and that roughly 1,500 of them have continued to subscribe to it.
In October 2021, just prior to the Open Enrollment period for obtaining health insurance, Southcoast wrote to all of its patients who used Senior Whole Health and who had a Southcoast primary care physician, informing them that they would have to change their senior care organization if they wanted to continue to be seen by their physicians or be cared for in their hospitals after the first of the year.
“Senior care organization” is a health industry term for insurers that cover both Medicare- and Medicaid-eligible individuals.
Senior Whole Health subscribers who did not change their health insurance last year could always change in the coming Open Enrollment period, which runs every October to December. If they are “dual enrollers” — people eligible for both Medicare and Medicaid — they could also change their insurance once each quarter for the first three quarters of the year.
Lees and other area medical providers that The Light spoke with said convincing a large population of elderly and disabled clients to change their insurers is not the easiest thing to accomplish.
“I think with Coastline, and with some of the people on Senior Whole Health, because they were the largest carrier in the area, it did create a lot of outcry and concern,” Lees said. “Some of the people had been on their plan for years.”
Cheryl Bartlett, the chief executive officer of Greater New Bedford Community Health Center, said that many patients see a doctor when they need help from their providers for a period of about 90 days; it is during those 90 days that they realize their doctor will no longer accept their health insurer.
GNBCHC had about 400 Senior Whole Health subscribers when Southcoast made its announcement. Through a proactive effort of its benefits department, Bartlett said the out-patient health service — which has a significant low-income clientele — whittled the 400 number down to about 60.
“We worked very hard to find them a different plan if they had wanted to continue to receive services from Southcoast Health,” she said.
Shawn Badgley, a spokesman for Southcoast Health, said the nonprofit community health care and hospital system “proactively” informed the 897 patients insured by Senior Whole Health and who had one of Southcoast’s primary care physicians that they would need to change their insurance to continue using their services. The letter listed options for Medicare/Medicaid providers accepted and information about other local health services if the patient did not want to switch, he wrote in a prepared statement.
“We recognize situations like these can cause concern for patients and their families, so reaching out directly via letter and phone call in advance of the Medicare open enrollment period was our most important consideration,” he wrote. The most important consideration was “to let these patients know that numerous in-network health insurance options were, and continue to be, available to those affected.”
In an email, Badgley said no additional letters were sent to patients who remained with Senior Whole Health and there were no plans to send out reminders this year. But he said he “would expect that the insurance company itself will keep its members informed of their options.”
Senior Whole Health is what health-industry officials call a dual-eligible health insurer. It insures people who are on both Medicare and Medicaid. Medicare is the federal health system that provides health care to senior citizens and the disabled; Medicaid is the federal system that provides care to low-income individuals.
According to KFF, a national health-policy think tank, Medicare and Medicaid reimburse hospital and health care bills at a government-set rate that is lower than private insurers.
Badley did not provide a specific answer to New Bedford Light’s question about why Southcoast ended its relationship with Senior Whole Health and neither did officials with the insurer. It also did not agree to The Light’s request for an interview with Dr. Rayford Kruger, its new chief executive officer.
Although Southcoast stopped accepting Senior Whole Health, it continues to accept other dual-eligible insurers including MassHealth, Commonwealth Care, Fallon, Tufts, United Healthcare, and Wellserve Health/BMC Healthnet.
“Southcoast Health is proud to offer a wide range of options for patients when it comes to insurance partners,” wrote Badgley in a statement. “As stated in our letter to patients affected by the Senior Whole Health discontinuation, focusing on other arrangements to provide the best possible array of in-network plans for all of the many communities we serve was a factor in our decision.”
The parent company of Senior Whole Health was equally vague about the reasons why it would not continue to do business with Southcoast Health
“Senior Whole Health is committed to ensuring access to quality care for our members in Bristol County and throughout Massachusetts,” wrote a Molina spokesperson in a statement to The Light. “We greatly value our providers, community partners, and other stakeholders, and look forward to continuing our work together in service to our members.”
Asked whether Senior Whole Health clients who failed to switch to another senior care organization can continue with their previous Southcoast doctors if they switch now, Southcoast issued a statement that was open but noncommittal.
“Southcoast always makes every effort to connect any patient with the provider of their choice, whenever possible,” the statement read. “We would encourage patients seeking care from a specific provider to call that provider’s office.”
Although medical professionals at multiple area health care companies contacted The Light about the fact that Senior Whole Health patients who could no longer be treated at Southcoast were showing up in their practices, none of them was willing to speak on the record.
Official spokespersons for Hawthorn Medical Associates and St. Anne’s Hospital in Fall River sent statements confirming that they had seen an increase in patients since Southcoast stopped accepting the Medicare/Medicaid insurer.
“Hawthorn Medical does accept Senior Whole Health for primary and specialty care,” wrote Kathleen Murray, a company spokesperson. “We have several primary care providers who are accepting new patients and they did see a slight uptick in patients after this announcement.”
“Yes, we have seen upticks in Senior Whole Health patients from the Fall River-New Bedford area across several services, such as radiology and oncology, in the last year,” wrote Anne Ferreira, a spokesperson for St. Anne’s Hospital. “We continue to welcome these patients, too.”
Email Jack Spillane at email@example.com