Molina Healthcare, Inc.: Terry P. Bayer, J.D., M.P.H., Chief Operating Officer, and Gloria Calderon, Vice President of Molina Medical Group

by HCE Exchange on October 11, 2013

Molina-Physician-thumbThirty years ago, Molina Healthcare was founded by a gentleman with the foresight to know that providing financially vulnerable patient populations with care in the emergency room would ultimately tax the healthcare system to the point of breaking.

To reach out to this population, many of whom were uninsured, non-English speaking, and dependent on government assistance and services, Dr. C. David Molina founded a medical home focused on preventive care provided by a physician who would be intimately acquainted with each of these individuals’ specific needs.

Dr. Molina’s family now carries on that work, and Molina Healthcare, Inc., has grown into a powerful $6-billion healthcare force across the nation, with a presence in 16 states, over 6,000 employees, and a provision of services to over 4.5 million people.

“All of our work is focused on folks with limited or uncoordinated access to care,” Terry P. Bayer, J.D., M.P.H., chief operating officer, said. “And our goal is to really provide high-quality healthcare that is cost effective, and where we have government funding our services, be good stewards of the public funds.”

Focusing on dual eligibles

Molina Healthcare is always in the process of identifying new markets in which to expand. As Bayer explained, the company has three components to its business line.

The largest segment of Molina’s business includes managed-care organizations, which are state-licensed HMOs designed to serve Medicaid, CHIP, and Medicare patients, specifically dual eligibles who qualify for both Medicaid and Medicare.

Molina participates in each state’s Medicaid managed-care program as well as CMS’ Medicare Advantage Special Needs Program (SNP), also with a focus on dual eligibles.  In addition, Molina has been selected to participate in Duals Demonstration Programs that fully integrate Medicare and Medicaid in Ohio, Illinois, and California. This is estimated to begin in 2014.

Molina Medicaid Solutions provides the second component of Molina’s business line. Acquired from Unisys Corporation three years ago, Molina Medicaid Solutions builds, operates, and administrates IT systems for Medicaid agencies in five states that are designed to better serve their fee-for-service populations.

Molina’s third and final business line is direct delivery through its primary-care clinics.

Dr. Molina began his career with a small medical clinic in Wilmington, Calif. The clinics are now owned by Dr. Molina’s son, Dr. J. Mario Molina, who administers them through one payer source, Molina Healthcare.

According to Gloria Calderon, vice president of Molina Medical Group, these clinics are located in Florida, New Mexico, Northern and Southern California, and Washington and “are basically there to care for Molina members and other low-income individuals and families.”

Managing the cost curve while coordinating care

Healthcare reform has emphasized the need to continuously improve execution on strategies for controlling costs, Bayer said. However, she added, “We look at managing the cost curve as going hand-in-hand with  providing high-quality services.” Molina believes “that by providing high quality, which means appropriate care, the right care at the right time with the right provider,” cost reductions often follow as a result.

To that end, Molina  centers its operations on patient-centered care management and coordination with the goal of improving outcomes and reducing unnecessary expense.

“We know that people also have not only physical health problems but mental health issues,” she explained. “They also face social problems related to their housing or their transportation needs. These are the folks that have fallen between the cracks.”

The solution, Bayer said, is found in providing comprehensive quality care targeting these three areas of need.

Providing support for all of a patient’s needs

Molina has embarked on a biopsychosocial model of care for its members, a model that recognizes a person’s needs may extend beyond physical problems.

“With this population, we have migrated to a model of care that is what we call Higher Touch, meaning more face time with our patients in the home setting and not always with a licensed medical provider, but often with a community health worker or a caregiver through a home-care program,” Bayer said. “So we’re really broadening the definition of the kind of healthcare we deliver and really supporting that with community health workers and ancillary practitioners and making sure people have the tools that they need to get healthy and not simply end up in the emergency room.”

Calderon said the clinics have also adopted this model, moving beyond children and young moms with babies to include the aging, blind, and disabled (ABD) population in their delivery of care.

“You’re looking at a set of patients that really need a higher level of care,” she said. “They have multiple chronic conditions, they also have significant mental issues, and so our waiting rooms are comprised of probably 25 to 30 percent of this ABD patient population.”

Since these patients are in need of other services when they come in, Calderon has hired more internists and social workers for the clinics.

“Rather than take the physicians’ or nurse practitioners’ time with that, we get those patients over to the social worker so that they can help them maneuver through the bureaucracy that is known as mental healthcare.”

Furthermore, Calderon has brought patient access coordinators (PACS) onboard who are there to supply members with services they need outside of the clinics, whether it be transportation, housing, or food banks. Calderon said Molina wants its members and patients to receive the full services they need.

This is completely in line with Dr. Molina’s original mission, Bayer explained, and is representative of the commitment that characterizes the physicians and healthcare professionals Molina hires.

“We have a fantastic organization that has really stayed close to its mission for over 32 years now,” she said. “The majority of the folks in management and throughout our organization at Molina are committed to making a difference in the healthcare delivery system, and they’re committed to increasing access and quality to healthcare services and government programs.”

-by Pete Fernbaugh

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