jonetta rose barras: Wellpoint DC’s CEO gets an award while Mayor Bowser’s administration angles to terminate the company’s contract

Sometimes the swirl of contradictions and ironies in government and politics can be interesting — fascinating even. Consider that this week the DC Hospital Association selected Adrian Jordan as a recipient of its Vincent C. Gray Health Equity Award. 

Established in 2023, the award was first presented to Gray, a former mayor, DC Council chair and Ward 7 representative. Now it has been renamed in his honor. Jennifer Hirt, an association spokesperson, wrote in an email to me that it is a recognition of “individuals and organizations that are making health equity a reality in their community and leveraging engagement to improve health outcomes for those at high risk for health disparities.”

Jordan is the president and chief operating officer of Wellpoint DC, a managed care organization formerly known as Amerigroup DC. Ironically, despite the public accolade, he and his company appear to be on the Bowser administration’s hit list yet again.

Five days after I initially reached out to Wellpoint, Chris Stenrud, vice president for public relations at its parent company, Elevance Health, finally decided to comment on the award being given to his colleague.

“This recognition reflects Adrian’s leadership and the tireless work of our team at Wellpoint DC to advance our mission of delivering equitable, high-quality care for our members across the District,” he said. “We appreciate this recognition from the DC Hospital Association and are grateful for our ongoing partnership to ensure the health of those we serve in the community.”

However, Stenrud said the company had “no comment” on other issues I raised, including the recent controversy surrounding Wellpoint’s contract with the city.

Mayor Muriel Bowser and Deputy Mayor for Health and Human Services Wayne Turnage are no fans of Jordan. In 2021, he was the president of Amerigroup when it filed multiple administrative complaints with the DC Contract Appeals Board (CAB) against the city for its handling of the managed care organization contracting process. The CAB forced a do-over. It wasn’t until 2023, however, that Wellpoint was finally awarded its contract.

Bowser and her team are back, seemingly with the proverbial vengeance. Recently, they asserted that Wellpoint committed 27 violations of its multiyear, multibillion-dollar agreement. Perhaps hoping to quickly resolve the conflict, Wellpoint submitted a corrective action plan. 

Last week, that initial plan was rejected. The company was given five days, which included this past Saturday and Sunday, to submit a new one. The deadline was Monday, Nov. 3, according to knowledgeable sources.

The latest skirmishes over the Medicaid managed care contract comes as the city is shaking up its health care delivery system. It has changed eligibility requirements, resulting in as many as 25,000 low-income residents being shifted to a Basic Health Care Plan permitted under the Affordable Care Act. The primary costs for that program will be covered by the federal government.

Meanwhile, the DC Council approved, on an emergency basis and by voice vote, four health care contracts worth nearly $4 billion over the next five years. That money will go to Aetna Life Insurance Co. and Aetna Health Inc. ($1,576,299,125.75); CareFirst BlueCross BlueShield/CareFirst BlueChoice Inc. ($769,361,993.67); Kaiser Foundation Health Plan of the Mid-Atlantic States ($806,032,713.45); and UnitedHealthcare Insurance Co. ($595,848,245.34).

A day before Tuesday’s vote, at-large Councilmember Christina Henderson, who chairs the Committee on Health, explained that “the companies provide health insurance benefits to District employees, their dependents and retirees.” She said of the 38,376 active DC government workers, “28,206 are currently covered under these contracts. There are also about 27,423 dependents and 3,000 retirees. 

“These numbers can change depending on hiring,” continued Henderson, adding the contracts were being passed on an emergency basis because open enrollment begins on Nov. 10 and runs through early December for District employees.

Henderson said the council “typically” does not hold a hearing on contracts “unless there is an issue.”

I spoke with a few DC government workers who do have “issues” with some of the contractors. They were denied care for serious medical problems, including in one case rehabilitation following a major stroke. 

How does one contractor seem to get so much more scrutiny than any other? 

When I asked Sisy Garcia, a public information officer for the DC Office of Contracting and Procurement, she told me via email, “When it comes to contract oversight of MCO contracts, [the Department of Health Care Finance] conducts both day to day administration as well as regular contract performance evaluations which are then reviewed by OCP.”

Just to be clear: I advocate for more — not less — oversight of government contractors, workers and agencies. However, it should be systematic and objective, with the clear goal of providing cost-efficient and effective services to DC residents. Executive branch authority certainly shouldn’t be used to bully or whip a perceived enemy into submission while creating a glide path for a political ally or favored company.

With the Medicaid contracts, there is seemingly some evidence of the latter, according to government documents and sources. Consider that Bowser administration officials have conducted two unannounced visits to Wellpoint DC’s office, as if they were the FBI and the managed care company had engaged in criminal activity. 

The infractions for which the company was cited seemed minor; many were unrelated to the quality of health care available to DC residents served by Wellpoint’s provider network. For example, several violations were related to whether employees were in their assigned seats in the office at the start of the day and whether they were working in the office or on site at least four days a week, as Bowser has mandated for government workers. 

There are more than a few executive and legislative branch offices falling short of that threshold. Hypocrisy and contradictions aside, should the government be imposing office hours for administrative employees of a private business? Even if it can do so in the case of a government contractor, should it exercise that authority?

Among other alleged Wellpoint violations: The company did not “ensure” submitted reports and deliverables were “properly certified for accuracy and completeness”; did not develop and submit a “comprehensive marketing strategic plan and outreach, health education and promotion strategic plan”; and did not “comply with requirements governing promotional gift incentives.” 

In its written response to the city, Wellpoint said it believed that its marketing and outreach plan “was approved as submitted.” It also said that no information had been provided by the Bowser administration nor did the company have any records that any enrollee received “more than the allowable value for incentive gift cards.”

To be fair, Turnage and his team may have some legitimate concerns about whether DC residents enrolled with Wellpoint can easily file a grievance or complaint about services and whether there are sufficient case managers for those with chronic illnesses or other special medical needs.

However, Wellpoint explained that its case management system is set up to look at not only standard and complex medical conditions but also factors such as housing, food and transportation access. It also noted that more than 400 people are enrolled within that program.

Still, Jordan repeatedly acknowledged that there was room for improvement, even when it appeared Turnage and his team may have misinterpreted data, documents and conversations with Wellpoint.

Continuing to self-muzzle, Stenrud, the Elevance VP, said “no comment” when I asked specific questions about the status of the various corrective plans; about whether he believed the perception of mismanagement would affect the company’s reputation and the willingness of DC residents to become Wellpoint managed care enrollees; and about whether the company was ensuring quality health care. 

Stenrud also would not comment on whether Wellpoint intends to file any kind of administrative challenge or formal lawsuit against the Bowser administration. Industry sources with whom I spoke didn’t rule out that course of action.

At least for now, Jordan can bask in the good feelings many in the city have toward Wellpoint. Dr. Edwin Chapman, known for his work to address the opioid crisis, called the CEO and his company “the best” in an email to me after an MCO-focused roundtable convened last month by Henderson. 

Chapman criticized other managed care plans, including AmeriHealth Caritas DC and MedStar Family Choice DC, for changing their bill-screening procedures. He said that resulted in “down coding,” a process that increased the cost for serving “high-risk” patients like those to whom he provides medical care.

When I asked Hirt why the DC Hospital Association selected Jordan for the Health Equity Award, she told me via email that his leadership “exemplifies a powerful commitment to advancing health equity by embedding Social Determinants of Health initiatives into its core strategy.”

She added that his efforts regarding “intentional community engagement, provider collaboration, and data-driven program design” are “transforming the health landscape for District residents disproportionately impacted by health disparities.”

That all sounds important to me. Maybe not so much to Turnage and Mayor Bowser.

jonetta rose barras is an author and DC-based freelance journalist, covering national and local issues. She can be reached at thebarrasreport@gmail.com.