Latest / Becker’s Payer Issues Podcast / Navigating Medicaid Redeterminations and Market Shifts with CalOptima Health Leadership with Michael Hunn & Yunkyung Kim

Transcript

Navigating Medicaid Redeterminations and Market Shifts with CalOptima Health Leadership with Michael Hunn & Yunkyung Kim · Becker’s Payer Issues Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400
• 0:10
  payer and health plan executives and more than
• 0:13
  100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George w
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
• 0:27
  and click on the events tab in the
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:33
  Hello, everyone. This is Jacob Emerson with the
• 0:36
  Becker's Payer Issues podcast.
• 0:38
  Thrilled today to be joined by Michael Hahn,
• 0:40
  who serves as the CEO of CalOptima Health,
• 0:43
  and YK Kim, who serves as CEO at
• 0:46
  CalOptima.
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  Michael, YK, thank you so much for taking
• 0:49
  the time to be with me on the
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  podcast today. Great. Thanks, Jacob.
• 0:54
  So, Michael, why don't you get us started
• 0:56
  by filling in the audience on anyone who
• 0:58
  might not be familiar? Can you tell us
• 1:00
  a little bit about your health care career
• 1:02
  background and then give us an overview of
• 1:04
  your current role at CalOptima?
• 1:06
  So I started my career in acute care
• 1:09
  hospitals.
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  I actually became a CEO at age 36.
• 1:14
  I've been sitting in the chair a lot
• 1:15
  of lot of years.
• 1:17
  I've run psychiatric hospitals. I've run long term
• 1:20
  acute care hospitals. I have run,
• 1:23
  community
• 1:24
  hospitals. I have run tertiary hospitals.
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  I've not had the privilege of running an
• 1:29
  academic medical center,
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  but I've had the privilege of working in
• 1:34
  as CEO, 12 different hospitals in my career,
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  six different,
• 1:39
  corporations or systems. And most recently, I ran
• 1:42
  the Providence Health System out here in Southern
• 1:44
  California.
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  So I've had a very,
• 1:47
  interesting career on the acute care side, including
• 1:50
  medical groups, long term care,
• 1:53
  long term acute care,
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  as well as,
• 1:56
  skilled nursing, as well as psychiatric,
• 1:59
  pediatric adult, and, geriatric.
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  And, and now on the Medicaid acute,
• 2:06
  health plan side for almost ten years now.
• 2:09
  Wonderful. Thanks, Michael. And how about you, YK?
• 2:12
  Jacob, it's a pleasure to join you today.
• 2:14
  I'm Yoon Kyung Kim, also go by YK.
• 2:17
  I'm the chief operating officer of CalOptima
• 2:19
  Health.
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  I've spent about twenty five years mostly in
• 2:23
  the public payer space.
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  My area of interest has always been in
• 2:28
  the Medicaid program and then the programs
• 2:31
  that serve the families and communities around Medicaid,
• 2:35
  including Medicare duals
• 2:37
  and the ACA programs.
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  I've had the pleasure of being able to
• 2:43
  see Medicaid, Medi Cal in California
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  from the lens of public plans like CalOptima
• 2:49
  Health, as well as from,
• 2:52
  the publicly traded plan space and the non
• 2:55
  profit space. I've worked in Medi Cal up
• 2:58
  and down California
• 2:59
  in multiple counties,
• 3:01
  and have seen again the differences
• 3:04
  in how each of the local markets function
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  based on size, based on the number of
• 3:08
  health plans,
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  based on the availability
• 3:12
  and the partnerships with health systems.
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  I've been here at CalAPNA Health now for
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  a little over four years in this role
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  and have the pleasure of leading our core
• 3:23
  operations
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  coupled with our provider network, our provider systems
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  and partnerships,
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  closely aligned with our technology, our IT team,
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  our quality.
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  We've really closely aligned quality with our provider
• 3:39
  partnerships as well as with technology.
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  And then also with our,
• 3:45
  business programs right now, that's Medi Cal and
• 3:48
  Medicaid for California.
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  Medicare, we have a dual eligible special needs
• 3:53
  plan, OneCare,
• 3:54
  and our PACE program program of all inclusive
• 3:57
  care for the elderly.
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  Wonderful. Well, YK, given your expertise
• 4:02
  on this topic,
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  I wanna get started by talking to you
• 4:06
  first about
• 4:07
  everything coming down the pipeline with HR one.
• 4:10
  As I'm sure you can imagine, this has
• 4:12
  been a major topic for leaders in this
• 4:15
  industry all over the country for the last,
• 4:17
  almost a year now since the
• 4:19
  or, yeah, just about a year, this summer
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  since the legislation was passed. And I know
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  CalOptima has really been doing a lot of
• 4:26
  work to prepare for this. The company has
• 4:28
  committed nearly $20,000,000
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  to help members navigate some of these eligibility
• 4:33
  changes stemming, from from the legislation.
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  And, you know, we've got work requirements
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  coming down the pipe, semiannual eligibility,
• 4:41
  redeterminations
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  starting next year.
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  So so how is your organization
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  operationally preparing to prevent
• 4:48
  large scale coverage losses,
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  looking into the next few years?
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  That's a great question.
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  You know, the changes under HR one, as
• 4:58
  you stated, are really around potential coverage losses.
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  They're,
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  they are, likely going to impact the number
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  of individuals and families who remain eligible for
• 5:10
  Medi Cal in California.
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  The thing that we've been really preparing for,
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  as you alluded to, is making sure that
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  our community stay informed
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  on the changes. There are a lot of
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  different
• 5:23
  eligibility
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  policies that go into play
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  at different times.
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  Coupled with HR one for California, we also
• 5:31
  have changes policy changes that are stemming from
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  state budget
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  policy,
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  decisions as well. So
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  the first thing that we've been doing is
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  really stressing the importance of
• 5:42
  factual, timely information for all of our communities.
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  And that includes not only our eligible members,
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  but also our providers.
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  So that as a community, we are clear
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  on
• 5:53
  what impacts we can
• 5:55
  expect to see and then how we can
• 5:58
  collectively get ahead of them. So to that
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  effect, we have committed nearly $20,000,000
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  to,
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  outreach, navigation,
• 6:07
  education,
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  information campaign
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  to make sure that no one is losing
• 6:12
  coverage
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  because they don't understand the changes or because
• 6:17
  they don't have the information to act on
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  those changes.
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  So that's really the first thing that we've
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  done, and that's also included educating our own
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  internal teams,
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  so that we can provide consistent
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  factual
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  information to everybody who's calling us, whether they're
• 6:34
  calling in through the customer service line
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  or if it's a provider
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  calling in to ask about contract,
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  or claims changes.
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  So that's the first thing that we're doing.
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  I think the second thing that we're doing
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  is really trying to partner with our providers
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  to make sure that they are well positioned,
• 6:52
  with information
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  to help them plan their not only their
• 6:55
  budgets, but also their operations. So as we
• 6:58
  get information, as we do our projections, we
• 7:01
  are sharing those with our providers.
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  You know, I think we've said this often.
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  Michael said this often. We are nothing without
• 7:07
  our providers. And so as we do the
• 7:08
  planning, the important thing really is at the
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  point of service,
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  how prepared are our providers to not only
• 7:15
  help their patients navigate,
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  but also to help their
• 7:21
  offices operationalize the changes and deal with potential
• 7:24
  patient losses, most likely patient losses.
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  So helping with those types of, support activities.
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  We also continue to
• 7:33
  promote as much
• 7:35
  access to health care right now as possible.
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  And, again, that also includes partnering with our
• 7:40
  providers about how they can
• 7:43
  expand access. That's not just a patient
• 7:47
  access issue, but it's also, I think, some,
• 7:50
  office and business planning for our provider offices.
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  How can they continue to see patients?
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  How can they continue to be reimbursed for
• 7:56
  seeing patients?
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  So we are continuing to, again, promote access
• 8:00
  to health care,
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  regular access to health care,
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  for as long
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  as everyone,
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  who is eligible remains,
• 8:08
  covered under those services.
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  Understood. A lot of different,
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  policy chain intricate policy changes going into effect
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  across a lot of different timelines, a lot
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  of communication that has to happen with your
• 8:19
  provider network and your members. Michael, anything you
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  would add here, and and going off of
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  what YK mentioned in terms of patient losses
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  for for your provider network,
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  can you share any projections in terms of
• 8:31
  how many of your members could lose coverage
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  over these next few years as a result
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  of this?
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  So I think, clearly, if I'm sitting in
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  a hospital CEO chair and I'm running an
• 8:41
  emergency department
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  as the enrollment
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  drops because there are new requirements
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  and impediments to receiving care.
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  That's gonna turn into uncompensated
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  care or charity care,
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  and with the restriction that we can't spend
• 8:58
  federal dollars on undocumented
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  individuals.
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  So, that's going to be a complicator.
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  And if I'm looking at that, I wanna
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  make sure I'm in front of
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  the enrollment numbers as they come down. So
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  what we do is I host a hospital
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  CEO consortium meeting
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  at our offices every quarter, and I invite
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  all the CEOs from the hospitals in our
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  community.
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  We have 44 hospitals in Orange County.
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  That includes our specialty hospital and our academic
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  medical center. We don't have any public hospitals.
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  So when a member loses enrollment, whether they're
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  undocumented or if they're a US citizen and
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  they let their enrollment,
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  lapse,
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  they're gonna end up potentially in the emergency
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  room with a critical issue,
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  and that's gonna be uncompensated
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  care. So we're trying to educate
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  our hospital CEOs
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  around how many individuals are up for reenrollment
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  in a given month.
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  We are talking about what we're looking at
• 9:58
  in terms of discharge planning.
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  We are starting to try to coordinate with
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  our community clinics
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  and any free clinics in the community,
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  particularly around the early issues with prescriptions.
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  So individuals who stopped taking blood pressure medicine,
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  individuals that stop taking insulin,
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  for diabetes
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  and other disease states,
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  that's gonna be the first hit are individuals
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  that lose coverage and then can't afford
• 10:27
  their medication,
• 10:28
  rent, and food. So they're gonna have to
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  give up something,
• 10:32
  and they're gonna keep a house hopefully over
• 10:34
  their head, but they may give up those
• 10:36
  prescriptions. So that's a real concern right now.
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  So we are in active conversation with our
• 10:41
  hospital CEOs and community,
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  hospitals to say, okay. What can we do
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  to
• 10:47
  figure out, alright. If we don't have access
• 10:50
  to Medi Cal or Medicaid,
• 10:52
  then what? How are we gonna work in
• 10:54
  the community? Where are there other resources?
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  And we're advising them that if we keep
• 10:59
  this collaborative going, keep the dialogue,
• 11:02
  let's coordinate with their discharge planners
• 11:05
  on where they can find those resources in
• 11:07
  the community. So those are a couple of
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  more things that I think particularly for those,
• 11:12
  that listen to the Beckers podcast,
• 11:15
  I encourage you, if you haven't sat down
• 11:17
  with your your local plan or your Medicaid
• 11:20
  plan, you need to. If you haven't sat
• 11:22
  with the social services folks at the county
• 11:25
  that may do the enrollments for your state,
• 11:27
  then you need to sit down with those
• 11:29
  folks.
• 11:30
  And with our communications plan, as YK pointed
• 11:33
  out, we wanna make sure that the frequently
• 11:35
  asked questions
• 11:36
  are all answered the same way.
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  So we have coordinated
• 11:41
  our FAQs
• 11:42
  with not only our call center for the
• 11:44
  health plan, but also with the county,
• 11:47
  with the hospitals, with the community clinics, with
• 11:50
  the federally qualified health clinics, and with our
• 11:53
  other community navigators so that no matter when
• 11:56
  the question gets asked by a Medi Cal
• 11:58
  or a Medicaid member,
• 12:00
  they get the same answer on what to
• 12:02
  do, how to do, and maybe where to
• 12:04
  go.
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  Absolutely. And, Michael, I appreciate the call out
• 12:07
  there and the reminder for our hospital audience
• 12:09
  listening in about the the real risk of
• 12:13
  care, the rise in uncompensated care on the
• 12:15
  horizon and and planning around that.
• 12:18
  I remember when you when you joined us
• 12:20
  last year here on the podcast,
• 12:23
  a piece of this conversation, you were telling
• 12:25
  us about,
• 12:26
  CalOptima's plan to begin offering health benefits on
• 12:30
  the ACA marketplace on on Covered California.
• 12:33
  That's the exchange there for our audience.
• 12:36
  And that's for the 2027
• 12:38
  plan year. The goal to serve the roughly
• 12:40
  15,000 members who churn in and out of
• 12:43
  Medi Cal eligibility.
• 12:45
  But, of course, since then, as you know,
• 12:47
  enhanced premium tax credits have expired.
• 12:49
  Marketplace enrollment is down a lot nationally,
• 12:53
  about a million people as of the current
• 12:55
  data. And and premiums have, have jumped all
• 12:58
  over, for subsidized enrollees. It's very expensive to
• 13:02
  purchase care on the marketplaces.
• 13:04
  So
• 13:05
  given all of that, any updates you can
• 13:07
  share with us on on the company's plan
• 13:09
  2027
• 13:10
  marketplace launch?
• 13:11
  So,
• 13:13
  YK has been leading the effort for us
• 13:16
  at the health plan.
• 13:17
  We are still looking to move forward, so
• 13:19
  I'm gonna let YK
• 13:21
  kinda comment on exactly where we are as
• 13:24
  we look to approach,
• 13:26
  the exchange and go on covered California here
• 13:30
  in the state.
• 13:31
  YK?
• 13:32
  Thank you, Michael.
• 13:33
  Jacob, you're right. You're thinking the exact same
• 13:36
  thing that we've been thinking of in terms
• 13:38
  of our marketplace launch for 2027
• 13:41
  and how the
• 13:43
  environment has really shifted since we initially
• 13:46
  started this
• 13:47
  plan. We are still working towards a 2027
• 13:51
  launch.
• 13:52
  We are right now in,
• 13:54
  the the depths
• 13:56
  of applications
• 13:57
  and licenses
• 13:58
  and working with our providers on contracts, but
• 14:01
  all of that work,
• 14:03
  has maintained
• 14:04
  the speed and pace that we wanted to
• 14:07
  for a 2027
• 14:09
  launch.
• 14:10
  You're right. The environment has really changed. It's
• 14:12
  becoming,
• 14:14
  a costlier
• 14:15
  purchase in a market than it was a
• 14:17
  year ago when we were doing this. But
• 14:19
  I think that still speaks to the reason
• 14:22
  why CalOptima Health
• 14:24
  embarked on this. We want it to be
• 14:26
  a local affordable option
• 14:29
  FOR OUR MEMBERS AND THEIR FAMILIES.
• 14:32
  When their life circumstances change, and life circumstances
• 14:36
  are certainly changing right now,
• 14:38
  we think that we can still be, especially
• 14:40
  in this current evolving market, we can continue
• 14:44
  to provide
• 14:46
  a low cost option, an option for our
• 14:48
  our families
• 14:50
  that still provides continuity with our providers,
• 14:53
  a familiar health plan who has, you know,
• 14:56
  known their health care and known their family's
• 14:58
  health care. So in a way, while cost
• 15:01
  may be rising, it I think that speaks
• 15:03
  to an even more critical
• 15:05
  reason as to why a public plan like
• 15:08
  CalOptima Health
• 15:09
  would consider entering the market at this time.
• 15:13
  We've been keeping a close eye on enrollment.
• 15:15
  For Orange County,
• 15:17
  we have seen that enrollment has not significantly
• 15:21
  dropped as of yet.
• 15:23
  Of course, we're keeping close eyes on that.
• 15:25
  But
• 15:26
  regardless of, I think, the number of members
• 15:28
  that we may attract for those who need
• 15:31
  a local
• 15:32
  health plan,
• 15:34
  we wanna be there for them, whether it's
• 15:36
  the 15,000
• 15:37
  that we had expected at the beginning or
• 15:40
  or a smaller number than that.
• 15:42
  Sounds like a very fluid situation in terms
• 15:45
  of some of the data, but good to
• 15:46
  hear that our CalOptima will be there as
• 15:48
  an option, for families next year,
• 15:51
  if that is something that they do pursue
• 15:53
  coverage wise.
• 15:54
  Let's switch gears here. And and, Michael, I
• 15:56
  wanna talk about, your retirement, which you announced,
• 16:00
  just a little bit ago,
• 16:02
  for effective for the end of this year,
• 16:04
  2026.
• 16:05
  Congratulations, by the
• 16:06
  way.
• 16:08
  But, you know, it's been quite an interesting
• 16:10
  period where you've been at the helm of
• 16:11
  CalOptima.
• 16:13
  As you know,
• 16:14
  you started there as interim CEO back in
• 16:16
  2021.
• 16:17
  You've led the company through a lot of
• 16:18
  big periods for the for the health insurance
• 16:20
  industry in general. There's the Medicaid unwinding period
• 16:24
  post COVID. You launched street medicine
• 16:26
  programs.
• 16:27
  You stood up a a CalAIM
• 16:29
  department to meet some of the new state
• 16:31
  requirements with California,
• 16:32
  invested $50,000,000 in workforce development,
• 16:36
  set this this marketplace launch in motion.
• 16:39
  So given all of that, what are you
• 16:41
  most proud of of accomplishing,
• 16:43
  during your time at the company?
• 16:45
  So I made a commitment,
• 16:47
  to be here five years, and I'll be
• 16:49
  here five years as of November.
• 16:52
  And so I told the board that I
• 16:54
  think in fairness to the next CEO, they
• 16:56
  should start
• 16:57
  in January
• 16:59
  to assume the budget,
• 17:01
  for next year.
• 17:03
  And in this last,
• 17:05
  four years and the fifth year to finish
• 17:07
  out at the end of this year,
• 17:09
  I think what I'm most proud of is
• 17:11
  the fact that we have built trust,
• 17:13
  with our members and in the community.
• 17:16
  When we first started to host community events,
• 17:18
  we wouldn't have a lot of folks show
• 17:20
  up.
• 17:21
  And over this four years now, just as
• 17:23
  an example,
• 17:25
  this past year's back to school event,
• 17:28
  we have almost 4,000
• 17:30
  people.
• 17:31
  And, again, between kids and parents,
• 17:34
  it's impressive to see the individuals come.
• 17:37
  I look at, the sum 330
• 17:40
  community events that we participated in last year
• 17:43
  here in Orange County, California.
• 17:45
  And without fail,
• 17:48
  the magnitude of our members coming and looking
• 17:50
  for assistance, help, advice, guidance, navigation,
• 17:55
  has really been heartening. They come to the
• 17:57
  events, and, of course, we're coordinating
• 17:59
  with our clinic and community partners. So whether
• 18:02
  it's food resources,
• 18:03
  whether it's immunization
• 18:05
  resources, dental and eye care,
• 18:07
  our community partners show up. And I think
• 18:10
  we've built a an incredible collaborative with our
• 18:13
  community partners and also our schools and our
• 18:16
  school districts
• 18:17
  as well as our city governments.
• 18:20
  And, certainly, we've kept our state and federal
• 18:22
  legislators well informed,
• 18:24
  and we have a lot of participation
• 18:26
  from them at our community events.
• 18:28
  So what I'm proud of is the trust
• 18:30
  that's been built
• 18:32
  between us and the members,
• 18:34
  us and our community partners,
• 18:36
  us and, you know, the districts, the school
• 18:39
  districts, and the elected officials.
• 18:42
  And most importantly,
• 18:43
  when I look at it from the providers,
• 18:45
  our hospitals, our doctors, our
• 18:46
  doctors, our clinics,
• 18:48
  we're all in this together.
• 18:50
  And I think we come together routinely now
• 18:53
  to solve problems
• 18:55
  and figure out what can we do together
• 18:58
  to be successful.
• 18:59
  That's what I'm most proud of.
• 19:02
  Wonderful. Well, congratulations again, Michael. It's been, great
• 19:05
  getting to hear about all the things,
• 19:08
  that CalOptima has done over these last few
• 19:10
  years, here from our perspective.
• 19:13
  But before we go today, is there anything
• 19:14
  else you'd like to share with the audience?
• 19:16
  Any final bits of advice, while you have
• 19:18
  the ears of a lot of other leaders
• 19:20
  from across the country?
• 19:22
  So, again, for all the different CEOs and
• 19:24
  executives and aspiring executives that listen to these
• 19:28
  podcasts about
• 19:30
  how to lead in times of change.
• 19:33
  I have standard sayings that I use with
• 19:35
  the team why k knows them well. First,
• 19:38
  I'm not here to admire the problems.
• 19:40
  Let's make sure that we're dealing with the
• 19:42
  issues head on. Second,
• 19:44
  don't confuse
• 19:46
  activity for accomplishment.
• 19:48
  We can be running around thinking we're accomplishing
• 19:51
  something, but if you can't put a number
• 19:52
  up on the board
• 19:54
  and you can't show that you actually did
• 19:56
  something, in our case, for the member,
• 19:58
  it's not that I called them five times
• 20:00
  to get a doctor appointment.
• 20:02
  It's I called them. I got the doctor
• 20:04
  appointment, and they went to the doctor.
• 20:06
  Check mark. Now I have an accomplishment.
• 20:09
  And finally,
• 20:10
  always do your work with a purpose of
• 20:12
  mission. You have to love what you do.
• 20:14
  You have to be engaged in what you
• 20:16
  do,
• 20:17
  and you have to show up with a
• 20:18
  spirit of kindness.
• 20:20
  And I think when we do all those
• 20:22
  things in leadership,
• 20:24
  our members benefit, our organizations
• 20:26
  benefit, our communities benefit,
• 20:29
  and we as professionals and individuals benefit
• 20:32
  because we end up ultimately doing the right
• 20:35
  thing.
• 20:36
  YK, how about you? Any other final thoughts
• 20:39
  or final bits of advice you'd share with
• 20:40
  the audience?
• 20:42
  No. Thank you. You know, I think one
• 20:44
  of the things that really Michael alluded to
• 20:47
  for Orange County has been,
• 20:49
  our building trust with our local community and
• 20:52
  us sharing information, reaching out to each other,
• 20:56
  but not,
• 20:58
  looking to just protect ourselves. And I think
• 21:00
  that that's really what's going to help us
• 21:02
  get through the next few years of all
• 21:04
  of these changes,
• 21:05
  policy changes, budget changes.
• 21:08
  We don't do health care alone. The payers
• 21:11
  and the providers,
• 21:12
  I think it's easy for us to try
• 21:15
  to go into retraction mode to protect ourselves.
• 21:18
  We won't get through this if we do
• 21:19
  that.
• 21:20
  I think it's a real important time for
• 21:22
  us to be reaching out to each other,
• 21:24
  for payers to reach out to providers and
• 21:26
  vice versa,
• 21:27
  and figure out how we can serve our
• 21:30
  shared patients together. So that would be my
• 21:32
  final thought for today.
• 21:35
  Wonderful. Well, thank you both very much for
• 21:37
  taking the time to chat with us and
• 21:39
  for sharing your insights and all the latest
• 21:41
  that's going on at CalOptima.
• 21:43
  We really appreciate
• 21:44
  it. Thank you. Have a great rest of
• 21:46
  your week.
• 21:47
  And to our audience, if you'd like to
• 21:48
  listen to more podcasts from Becker's, you can
• 21:50
  visit beckershospitalreview.com.