Patricia J. Darnley, the new president and CEO of insurer Gateway Health, has returned to Pittsburgh after having spent eight years in St. Louis with Centene Corp., a managed care company.
First things first -- Cardinals or Pirates?
"It became really complicated," she admitted. "When we moved there, [we] started cheering for the Cardinals. They actually won the World Series the year we moved there, and the Pirates weren't doing anything."
But the last time she attended a baseball game in Pittsburgh, having won a trip here, "My friend, he wore St. Louis. And I had to wear the Pirates."
You can take the woman out of Pittsburgh, but you can't take the Pittsburgh out of this South Hills-raised health care executive, who worked as the chief financial officer at UPMC Health Plan and also at the predecessor to Highmark Inc. before taking the job with Centene nearly 10 years ago.
At Gateway, she'll be running a company that claims about 300,000 customers, with 250,000 of those in Medicaid plans and the balance in Medicare-related plans, such as those for special needs patients. Last year, Gateway reported $1.6 billion in annual revenues.
When the Gateway CEO spot opened up following the September retirement of former CEO Michael Blackwood, the timing was right. Both of her children are in college, and with her son in his last year at Duquesne University, "The fact that it was in Pittsburgh was kind of an added benefit," Ms. Darnley said.
She's been with Gateway for just a month, and though she's re-familiarizing herself with the lay of the landscape in Pennsylvania, she brings a multistate perspective to the position: Centene operates in 19 states, with 19 different local health plans.
But those experiences won't necessarily aid her here, even though Gateway is now a multistate operator. As of Jan. 1, it began serving segments of Ohio's Medicare populations.
"In the Medicaid environment, when you've seen one Medicaid program in one state, you've seen one Medicaid program in one state," she joked. In other words, it's not a "seen one, seen 'em all" proposition.
Medicaid is the state-operated health plan for the poor, disabled and other vulnerable populations.
Ms. Darnley comes to Pennsylvania at a time when the governor's office is pondering how to proceed with potential expansion of, or overhaul to, the state's Medicaid program. The 2010 Affordable Care Act sought to relax income eligibility requirements for enrollment in Medicaid, allowing anyone below a certain income level to apply for coverage.
The federal government is also paying 100 percent of the extra Medicaid costs for three years, starting this year, and will scale back to 90 percent of extra cost thereafter.
But participation in expanded Medicaid is optional, as per the 2012 U.S. Supreme Court ruling on "Obamacare" that upheld most of the law but pushed back on the mandatory Medicaid growth.
Currently, 25 states and Washington, D.C., have accepted the billions in Medicaid subsidies. Republican Gov. Tom Corbett has not, saying it would cost the state too much. He is, however, contemplating a "premium assistance" plan that would give subsidies to about 520,000 low-income Pennsylvanians to allow them to buy insurance on the newly created federal health care exchange.
He also wants the state's unemployed and uninsured to search for work while receiving the premium subsidies, but both the "work-search" requirement and the rest of the Medicaid overhaul would need federal approval.
Ms. Darnley was mum on whether she would prefer an outright expansion -- which would theoretically add to the Gateway population -- or some kind of premium assistance model.
"We support anything that allows the individuals to get to the care that they need," she said.
Getting the uninsured out of the habit of using the emergency room as a doctor's office -- which costs more than a visit to a primary care physician -- is an imperative, she said, not just because it's cheaper, but because people who get regular medical care are more likely to catch small issues before them become big one.
Easier said than done -- a study published last month concluded that people newly enrolled in Medicaid went to the emergency room 40 percent more frequently than others. While new Medicaid beneficiaries also report improved mental health and improved personal finances, the mere act of Medicaid enrollment does not wipe out unnecessary ER visits.
"When the population first goes in there, overnight, they don't change," Ms. Darnley. "What changes is, now you have a Medicaid organization that's watching their behavior, starting to work with them, doing the outreach they need."
But, "You're not going to see it the first day," she said.
Over the next year, Ms. Darnley said, she and the rest of her team will continue to look at growth opportunities, both in terms of program offerings, as well as a possible expansion of Gateway's geographic footprint.
"We're in our infancy [in Ohio], but we'll continue to look there, [and anywhere] else it might make sense to expand those type of programs," she said. "It's something that we're going to explore."
Exploration and implementation -- building a website, building health plans that meet a particular state's specifications, marketing the plans, assembling a provider network -- takes up to two years.
Gateway is half-owned by Highmark Inc. and half-owned by Mercy Health System in Philadelphia.
Bill Toland: firstname.lastname@example.org or 412-263-2625.