This article first appeared in the St. Louis Beacon, July 23, 2012 - Shannon Bagley has a passion for crunching numbers and for seeking good care for the medically needy. These interests come from her training as a CPA and growing up in central Illinois where her mother worked for the Illinois Department of Children and Family Services.
She is combining her knowledge of health-care economics and medical services in her job as president and CEO of Home State Health Plan. A subsidiary of Centene Corp., Home State was one of three companies that won contracts to handle managed care for Mo HealthNet, the state's Medicaid program. The managed-care component serves about 410,000 people.
"I chose health care (as a career) based on my upbringing," says Bagley, referring to her mother's two decades of work for the Department of Children and Family Services in central Illinois.
"I saw first hand the importance of insuring that health care was available for the most vulnerable citizens. Every day I can help make a difference in somebody's life. It cannot get any better than that."
She says Home State's approach stands out partly because of its ground-breaking partnership with the Missouri Primary Care Association and a dozen MPCA member community health centers across Missouri.
"We believe that this is an innovative model, an ownership model, which allows providers in participating community health centers to help shape the policies and practices of the Home State health plan. It further advocates for patients and efficiency in a health center's delivery system."
Joe Pierle, CEO of the primary-care group, says the partnership amounts to adding a new voice to a managed-care company.
"When you look at managed care historically, you think of tension or conflict between the companies and providers," he says. "But we really see this as a way to bring the patient's voice to managed care and look out for the patient's needs."
He says the partnership gives the providers a "very small" ownership stake but a "large voice" in structuring policy. "The company has done a lot of outreach to us, asking for advice in the development of the plan and in the implementation." He says input by MPCA and member health centers "could be as simple as (supporting) a service that patients need that isn't covered by the plan."
The managed-care enrollment period began July 1. Participants have until Sept. 30 to choose, change or be automatically assigned to a plan offered by either Home State, Health Care USA, or Missouri Care Inc., the three contractors. While praising the partnership with Home State, Pierle stressed that all MPCA member health centers will accept and treat patients enrolled in any of the three managed-care programs.
As Missouri's newest managed care provider, Home State estimates it might sign up between 46,000 to 49,000 members during its first year. The company provides similar service in 17 markets in other states.
One incentive for patients to choose Home State is the company's nationally recognized financial reward system for those who take better care of themselves. Low-income pregnant women, for example, are less likely to get prenatal services and often have poor birth outcomes, like prematurity and low-weight newborns. These, in turn, can increase the amount and cost of care for mother and child.
To encourage a woman to get prenatal care regularly, the plan rewards her with $30 for the third, sixth and ninth prenatal visits and another $10 for the initial postpartum visit. Other rewards include $30 for making a series of well-child visits to a pediatrician, and $10 for a well-adult visit to a doctor. The idea is to focus on early detection of health problems before they become needlessly expensive to treat.
Bagley describes the partnership as innovative, noting that the MPCA has more than 25 years of experience in promoting policies and initiatives to improve health access.
"We believe that approach, coupled with Home State's nationally- recognized, award winning member programs, will ultimately improve outcomes and reduce and remove barriers to care."
Her passion for this job comes through as she talks of a seamless execution of Home State's program through its "boots on the ground, member outreach, eagerness to become involved in and part of the community," and an ongoing focus on innovations to continue improving its managed-care product.
In addition, she says Home State uses data "that we build into predictive modeling tools" to help identify and respond to patients who might need additional outreach services through telephone and home visits.
While the use of case managers and outreach workers is a popular trend currently in health care, Bagley says these approaches already are "embedded in our culture. This is our business model. We continue to refine it to drive quality outcomes."
