Sentara Health Plans President Michael M. Dudley says his company and HHHS anticipate a 50-50 risk sharing arrangement under the RCO.
"This is not new business to us. We've been in this business for 30 years and more specifically, Medicaid managed care for about 20 years here in Virginia," Dudley said in a telephone interview. "We serve about 170,000 members all over Virginia. We are a statewide provider of Medicaid services in Virginia and have a pretty good track record of serving this population."
"We see it as a great opportunity to scale up a business line that we have done very well with in Virginia and we think we have a lot to offer the good folks of Alabama as they are moving into more of an accountable care scenario with how they deliver services to Medicaid populations."
Dudley acknowledged that the waiver for the program has yet to be approved, "but if we waited until the waiver was granted it would be way too late to implement on schedule that we now have for October 2015. So, we are beginning to make plans for implementation. We are working well with our partners in Alabama and we expect the waiver will be granted in the next few months and everything will fall into place."
Spillers says HHHS wanted a partner with the expertise in managing Medicaid populations and who was willing to share the risk under the capitated model for the population they're serving.
"We felt like if they had skin in the game they're more likely to make sure we are successful," he says. "If you are just providing services and you are going to make your money regardless of what happens to us that is not a partnership as far as I am concerned."