By Mike Sherry
Heartland Health Monitor
KANSAS CITY, Mo. — A Maryland company that has reaped millions of dollars in federal health reform grants for work across the country is drawing fire for its performance in the Kansas City area.
Critics say that Advanced Patient Advocacy (APA), a privately held company, has been slow off the mark in its role as a “navigator” organization, charged with helping consumers find coverage through the health insurance marketplace established by the Affordable Care Act.
Critics also question whether the company, which houses its local staff in for-profit hospitals owned by Nashville, Tenn.-based HCA, is fulfilling its obligation under a nearly $400,000 grant to conduct outreach and education activities in the community.
Local health reform advocates are unsure why the federal Centers for Medicare and Medicaid Services (CMS) chose APA for Missouri-side work when last year’s grantee seemed to be doing a good job – and when some people here were unhappy with previous navigation work done locally by APA.
“For $400,000, what are we getting for our tax dollars? I would like the answer to that question,” said Elizabeth Darr, a retired OB-GYN who has been active helping people sign up for health coverage.
CMS’s choice of APA to serve the Missouri side of the state line this year baffled some members of the local marketplace enrollment network, who meet regularly through the bi-state Regional Health Care Initiative. The initiative is headed by Scott Lakin, a former Missouri insurance commissioner.
Lakin said some members of the marketplace committee gave low marks to APA for its enrollment efforts in Kansas last year. He also said he was disappointed that company representatives did not attend meetings of the marketplace committee last year or at the start of this enrollment period – though he is encouraged by the company’s recent participation.
APA officials say the company’s slow start this year is due in part to CMS releasing funds only in October. They say they’re now busy making up lost ground.
Previous navigator got high marks
APA replaced Shepherd’s Center Central, a Kansas City, Mo.-based nonprofit that provides Medicare counseling and other services in the metropolitan area to middle-aged and older adults.
Shepherd’s Center was part of a statewide consortium established by Primaris, a health care consulting firm based in Columbia, Mo., which received a $1.1 million navigation grant for the first open enrollment period.
The enrollment community gave high marks to Shepherd’s Center for the cadre of committed workers it put together to serve as navigators during the first enrollment period.
Primaris officials, too, said they were disappointed at not getting their grant renewed and were proud of their accomplishments in the first year, especially given the early challenges they faced when the federal enrollment website, healthcare.gov, was plagued with technical problems.
The consortium enrolled about 1,500 people in marketplace plans, said Robin Corderman, a consumer assistance program manager with Primaris and one of its affiliates. In all, she said, the consortium made contact with nearly 40,000 consumers.
Corderman said Primaris has tried for months to get feedback on its grant application from CMS, with its initial inquiry coming the day the agency announced the second round of grants.
“We have received nothing,” she said.
In response to questions submitted by Heartland Health Monitor about APA’s selection, CMS was willing to provide only background information about the bidding process.
The agency said via email that an objective review panel scored grant applications, in part based on applicants’ prior performance.
CMS said it was aware of concerns raised about APA’s performance thus far in Missouri and was working with the company to iron out issues. It said it would continue to monitor the situation.
U.S. Rep. Emanuel Cleaver, a Kansas City Democrat, also is keeping tabs on the situation, according to a statement from his office.
“Congressman Cleaver is focused on ensuring that all of his constituents have good access to quality health care and he has heard from some individuals concerned about our region, and he is monitoring the situation closely,” the statement said.
Understanding the options
As of October, a year after the start of the first open enrollment period, 7.1 million people nationwide had enrolled in marketplace plans, according to the Department of Health and Human Services (HHS). Of that number, 57,000 Kansans and 152,335 Missourians signed up for a marketplace plan.
So far, 6.5 million consumers have selected a plan or were automatically re-enrolled at healthcare.gov in the first five weeks of the current open enrollment period, which runs from Nov. 15 through Feb. 15. That figure does not include numbers from state-operated exchanges.
Navigators are part of an extensive consumer-assistance network established under the health reform law to help consumers – many of them obtaining health insurance for the first time – understand their options in the health insurance marketplace. On Sept. 8, HHS announced it was awarding $60 million in navigator grants to organizations around the country for the 2014-2015 enrollment period.
APA received a total of $1.7 million in grants to act as a navigator in four states: Missouri, Tennessee, Virginia and West Virginia. In the previous enrollment period, APA was awarded $1.4 million to provide navigation services in four other states: Florida, Kansas, Virginia and West Virginia.
Sense of mission
The chief executive of APA, Kevin Groner, once served in the Peace Corps. APA’s chief marketing officer, Rodney Napier, said Groner founded the company in 2000 with that same purpose of serving others.
Through contracts with about 100 hospitals across the country, Napier said, the company works with uninsured patients to see if they are eligible for coverage through any number of approaches, including Medicaid or even car insurance if the hospital visit is related to an automobile accident.
Napier said company officials view the navigator program as a natural extension of that service.
Although the company knew of its award in September, it did not have its full contingent of four local navigators in place until last week – six weeks after the start of open enrollment.
Napier explains that APA did not have access to salary funds from CMS until the end of October.
“We made up that ground as quickly as we possibly could,” he said.
Napier also said the company fulfills its outreach and education obligations by participating in events like community health fairs. It focuses a lot of its activities on hospitals, however, because he said that’s where people can talk confidentially about their health care needs.
Napier noted that APA’s existing relationships with hospitals also allow it to stretch its federal grant through the use of in-kind hospital services such as meeting rooms and copying machines.
Some local critics are wary of those relationships, saying APA’s participation as a navigator amounts to a private company using federal dollars to pad the bottom line of hospitals by ensuring that more of their patients have a payer source.
Napier said that APA keeps a strict firewall between staff working on traditional APA services and the people it hires as navigators. He said its hospital customers want it that way and, in any case, it’s an accounting requirement of the federal grant.
“Our heart is in the right place – it’s what we have been doing for 14 years, it’s what our company has been founded on,” he said. “That is what we wake up every day doing, with or without a navigator program.”
Mike Sherry is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.