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ABQ’s Presbyterian to manage Medicaid in North Carolina


This 87,000-square-foot addition to Presbyterian Healthcare Services’ corporate headquarters will house new employees doing Medicaid management services for a future North Carolina venture. (COURTESY Presbyterian Healthcare Services)


Presbyterian Health Plan of New Mexico has signed a letter of intent to provide Medicaid managed care services to a group of 11 health systems in North Carolina, possibly bringing as many as 600 jobs to Albuquerque.

The partnership, which is subject to approvoval by the Centers for Medicare Services and North Carolina insurance regulators, is called Provider-Led Patient-Centered Care. If given the green light, Presbyterian Health Plan will become a minority owner of the new entity.

Jim Hinton, CEO and president of Presbyterian Healthcare Services, and members of his executive team unveiled the new collaboration Thursday in a meeting with the Journal editorial board.

“They liked our Medicaid expertise,” Hinton said of North Carolina’s leading health systems, adding that the Albuquerque-based Presbyterian was one of three vendors vying for the business.

The company is planning a $20 million addition to its corporate headquarters in Albuquerque to accomodate the new workforce.

Presbyterian operates a for-profit Medicaid managed care plan for 208,000 New Mexicans, about 30 percent of the state’s beneficiaries.

Lisa Lujan, president of Presbyterian Health Plan, said North Carolina network will  target the Tar Heel state’s 1.6 million Medicaid beneficiaries. She anticipates the first members will be enrolled between July 2018 and July 2019.

“The lead time on this is very long,” she said of the new enterprise, but Presbyterian will begin gearing up well in advance of that.

Provider partners include Duke University Health System, University of North Carolina Health Care and Wake Forest Baptist Medical Center.

In terms of market share five years out, “We would love to have  (at least) 25 percent of the Medicaid” population, she said. Medicaid spending in North Carolina is estimated at $12 billion, said Lujan.

The new venture would add some “good quality” jobs in Albuquerque as PLPCC builds market share, said Lujan. The jobs would include customer service, claims processing, member outreach, marketing and care manager positions.

“It’s a good story for the New Mexico economy,” said Hinton, who said the new business won’t dilute the company’s effectiveness in serving New Mexicans and building its Medicaid service line. He said expected revenue from the North Carolina operation will enable Presbyterian to fund new clinics, hire more doctors and defray the costs for indigent care in New Mexico.

Presbyterian will have a stake in the “20-plus percent” range once the dust settles on the deal.

“We wanted an equity position. We wanted to have a voice rather than just pay claims,” said Hinton.

Presbyterian Health Plan is organized as a for-profit company, which is wholly owned by non-profit Presbyterian Healthcare Services.

The new workforce will be housed in an addition to Presbyterian’s corporate headquarters at Cooper Center, at the corner of San Mateo NE and Balloon Fiesta Parkway.

There is no specific timeline, but the healthcare system hopes to be able to break ground in this year on the new wing. The expansion would include three stories and an additional 87,000 square feet.

Presbyterian originally selected the Cooper Center location because it could accommodate its existing workforce and provide room to expand.  The center already houses about 2,200 employees and is near capacity.

Presbyterian’s application to the city’s planning department also includes an additional three-story building for a future phase, but there is no plan to develop this building any time soon, a spokeswoman said.

In addition to the 600 new jobs in Albuquerque, Presbyterian could have roughly that many employees in North Carolina.

Presbyterian, including health systems and its health insurance plan, is the state’s second-largest private employer with a work force of about 11,000. It has annual revenues of about $3 billion.


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