By PHIL DRAKE
HELENA – Gov. Brian Schweitzer on Tuesday criticized several Montana caregivers for allegedly leaving the state out of the loop concerning changes the state needs to be making as mandated by federal health care reform. And the governor also spoke about rising Medicaid costs in the state.
Specifically the governor spoke about Accountable Care Organizations that he said were mentioned 70 times in the Patient Protection and Affordable Care Act of 2010, commonly referred to as Obamacare, and had to be in place by 2012. According to the governor’s office, ACOs are providers who get paid or a financial incentive for caring for a specific group of patients.
Currently there are no ACOs in Montana, the governor said, and then accused some of the groups in attendance, such as Blue Cross and Blue Shield of Montana, the Montana Hospital Association and the Montana Health Care Association, for not including the state in any of the discussions.
“So you knew the clock was ticking, knew we had to come up with ACOs by 2012, but none of you called us?” he asked, adding that under the Affordable Care Act an additional 55,000 people will be added to Medicaid’s 101,000 currently enrolled.
“ACOs don’t happen overnight,” said Sherry Cladouhos, chief executive officer of Blue Cross and Blue Shield of Montana. “We have a lot to learn in this area. We’re working on that and it doesn’t happen overnight.”
The governor also pointed out the high cost of Medicaid, noting that Montana is among the top seven states with the highest provider reimbursement rates in the nation, but ranked second from the bottom in income. He also said the state paid $6,385 per person for Medicaid, which is $1,200 more than the national average.
“How is it a state like Montana pays more than (33 percent of) the national average?” Schweitzer asked. “Honest to God it scared me.”
 He has proposed that a five-county pilot project could examine how increased coordination could help patients get more preventative care to prevent life-threatening and costly emergencies, coordinate infrastructure to reduce administrative costs and prevent duplicate tests and services, and allow the state to negotiate for discounted services.
Schweitzer said Montana has 369 private contracts with 1003 individual providers across the state, costing the state $5 million in management fees per biennium.
Some said they had felt bushwhacked by the governor’s criticisms.
“I was invited to a meeting on managed care and walked into a press conference instead,” said Rose M. Hughes, executive director of the Montana Health Care Association. “This was not designed for dialogue.”
She said there have been requests for meetings and was surprised by the tone of Tuesday’s news conference.
“I have been doing this for 30 years, if the state’s Medicaid agency was looking at doing something this significant, they would have invited the consumer and provider to the table,” she said.
Later in the day she produced copies of two letters sent to Anna Whiting Sorrell, director of the state Department of Health and Human Services asking questions about the managed care proposal the state is developing and requesting a meeting.  There is an Oct. 21 letter signed by 19 health care providers and a Nov. 3 letter requesting a response to the Oct. 21 letter.
The governor began the news conference like a high school pop quiz, asking those in the room if they knew if Medicaid paid more or less than Medicare (the answer was more) or if Blue Cross and Blue Shield paid more or less than Medicare.
Schweitzer seemed particularly miffed at a comment by Bob Olsen, vice president of the Montana Hospital Association, as reported in an Oct. 13 interview with the Lee State Bureau. The story was about the Schweitzer administration’s plan to have a private firm manage Medicaid, “the state’s $900 million health care program for the poor.”
We’re kind of in the dark on what the governor’s office is thinking,” said Olsen, whose organization represents most of the hospitals in the state. “There’s been no communication at all. … The only thing I can say is that we would be very interested in seeing the details of what they have in mind and how this might work.”
After the meeting, Olsen said the quote was in response to a specific question.
“It was the first time I had heard there was a proposal,” he said, adding in reference to the quote in the article, “It’s important when you see an answer to know what the question is.”