The company contracted to provide care for 30,000 legal Massachusetts immigrants and a spokesman for the state's health insurance exchange, Health Connector, harshly criticized a letter in Thursday's edition of the New England Journal of Medicinethat says those patients are being denied physician access.
"We believe that patients who were switched from Commonwealth Care to CeltiCare had inadequate access to primary care three months into this new program," Ruth Hertzman-Miller, MD and colleagues with the Cambridge Health Alliance (CHA), a CeltiCare competitor, wrote in a letter published in the Correspondence section of the journal.
Hertzman-Miller's letter states that according to CHA's telephone survey during the second and third months of the Commonwealth Care Bridge Program earlier this year, the for-profit insurance company CeltiCare's provider network listed 326 providers within a five-mile radius of the former providers, Boston Medical Center and CHA.
Of those, 119 were duplicates, and 25% could not be reached at the telephone number provided. Of those available by phone, only 37% were actually accepting new CeltiCare patients. The average wait, the letter says, was 33 days.
"In all, only 60 providers were accepting new CeltiCare patients and only 38 could provide service for even one of the three major linguistic minorities," Hertzman-Miller wrote. In a statement this week, the organization that advocates for a single-payer system, the Physicians for a National Health Program, said Hertzman-Miller's report "raises grave concerns not only about Massachusetts' reform, but also about the recently enacted national reform" that "closely mirrors Massachusetts'."
Asked for a response, CeltiCare issued statements calling the allegations damaging, and "both false and unfounded," and said it informed Hertzman-Miller about the inaccuracies last March.
In a statement, Robert LoNigro MD, chief medical director for CeltiCare Health Plan of Massachusetts, wrote, "independent and third party research commissioned by CeltiCare in March 2010 demonstrates members have access to care after their transition to the Bridge Program." He said that CHA's charges are based "on 'research' that was designed to fit the conclusion that they seek to draw."
Health Connector spokesman Richard Powers said the Bridge program "was developed and running in an amazingly short period of time. We take our oversight responsibilities very seriously and have worked closely with CeltiCare to make certain that every one of its members has a primary care physician, which they do." However, he acknowledged some initial start-up issues.
"It is not to say that the pace of the ramp-up, which coincided with the telephone survey, did not create turbulence and that information contained on the website was always current," he continued. "I believe a similar review now would demonstrate different results.
Asked to respond to accusations her letter is inaccurate, Hertzman-Miller replied, "It is true that at a glance, repeating the same five-mile radius today gives what looks like a list of about 700-800 physicians. However, just by glancing at the first few pages of the list, I can see that some providers' names are duplicated as many as six times, so the actual numbers may be far less."
She added that "the long cycle between initial submission of the article and publication is also a factor."
In her letter, Hertzman-Miller also said that CeltiCare agreed to take over the care of these immigrants "for only $1,300 per person, one third of the state's previous cost, and well below the average cost of adequate care nationally."
Powers, however, said that figure is incorrect, and is based on looking at a budget for only a portion of the fiscal year. Enrollees were phased in at different dates, depending on where they live, Powers said.