Pres­by­te­rian sees higher gain un­der Med­i­caid ex­pan­sion

Modern Healthcare - - REGIONAL NEWS - —Beth Kutscher

Pres­by­te­rian Health­care Ser­vices, a New Mex­ico sys­tem with hos­pi­tal and health plan op­er­a­tions, re­ported that the state’s re­vamped Med­i­caid pro­gram led to a larger sur­plus in its sec­ond quar­ter.

Al­bu­querque-based Pres­by­te­rian re­ported that its sec­ond-quar­ter op­er­at­ing mar­gin im­proved to 6.9%, up from 4% dur­ing the same pe­riod in 2013. In to­tal, the group re­ported a sur­plus of $84.6 mil­lion on rev­enue of $621.6 mil­lion com­pared with a sur­plus of $11 mil­lion on rev­enue of $533.6 mil­lion in the prior-year pe­riod.

Pres­by­te­rian is one of four health plans that were se­lected last year to man­age med­i­cal, long-term care and be­hav­ioral health ser­vices for Med­i­caid ben­e­fi­cia­ries un­der the state’s re­vamped Cen­ten­nial Care pro­gram. The re­designed plan—which of­fers Med­i­caid ser­vices through man­aged­care or­ga­ni­za­tions—went into ef­fect Jan. 1 and also ex­panded Med­i­caid el­i­gi­bil­ity for low-in­come adults.

Pre­mium rev­enue at Pres­by­te­rian in­creased 21.5% in the sec­ond quar­ter, as its at-risk health plan mem­ber­ship in­creased 6.5% year over year.

Al­though it saw a 1.5% de­crease in mem­bers in its com­mer­cial busi­ness, Med­i­caid ben­e­fi­cia­ries in­creased 10.1% and in­di­vid­ual mem­ber­ships in­creased 7.1%.

In its eight hos­pi­tals, in­pa­tient dis­charges in­creased 2.9% year over year while out­pa­tient vis­its were up 5.3%. Rev­enue from pa­tient care in­creased 6.5% in the sec­ond quar­ter com­pared with the prior-year pe­riod.

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