DAYTON — Back in the early 1980s, leaders in Montgomery County began looking for a way to improve care for local Medicaid patients, control the program’s costs and better facilitate payment to health care providers.
The Dayton Area Health Plan HMO was born.
Today, it’s called CareSource, and it has grown into the third largest nonprofit Medicaid HMO in the country, with $2.5 billion in revenue and about 800,000 clients in Ohio and Michigan.
Since the HMO’s inception in 1983, Tom Breitenbach, chief executive of Premier Health Partners, has had a hand in shaping CareSource. He continues today on the governing board of its parent, CareSource Management Group Services.
But in recent months, health care officials and providers have raised questions about whether the head of the region’s largest hospital system should sit on the board of the parent organization of the region’s largest source of Medicaid payments.
“How can that not be a conflict of interest?” said Dr. Larry Litscher, a Dayton area urologist. “They (the CareSource board members) have to determine the reimbursement levels” for hospitals and doctors providing service to CareSource patients. “How can that not be interpreted as a big advantage for the hospitals?”
But Pamela Morris, chief executive of CareSource, said the governing boards of CareSource and CareSource Management Group Services do not determine or approve the reimbursement rates for the HMO’s 25,000 health care providers. On occasion, she said, when a major provider has been targeted for a significant change in contract, the CareSource board is consulted.
Premier’s public relations office released a statement noting that CareSource bylaws have always required a board member from the health care industry. The board positions are unpaid. “Should the board be making a decision that would involve any Premier hospital, Tom (Breitenbach) dismisses himself and leaves the room,” the statement said.
Ellen Leffak, chairwoman of the CareSource board, agreed Breitenbach has been careful to avoid any potential conflicts. But she said a subcommittee is now exploring whether there could be situations of indirect conflict between Breitenbach’s role as chief executive at Premier and a board member at CareSource Management Services Group.
With the help of a consultant, CareSource began two years ago to look at ways of restructuring its governance to match its current size and complexity, Leffak said. Part of that exploration has been assuring the independence of its board members.
“Every board member was looked at,” she said, “and not just Tom.”
Contact this reporter at (937) 225-2437 or jdebrosse@Dayton DailyNews.com.