Insights – Wild Blue Health Solutions

Medicaid insights from Kaiser Family Foundation: Who may be at Risk as Continuous Enrollment Ends

Wild Blue — Sun, 05 Mar 2023 16:16:29 +0000

Medicaid Enrollment Growth: Estimates by State and Eligibility Group Show Who may be at Risk as Continuous Enrollment Ends

“Millions of people could lose coverage when the continuous enrollment provision ends, reversing recent gains in coverage.”

Who are the uninsured in Texas?

Wild Blue — Fri, 03 Mar 2023 18:30:09 +0000

The “Texas 2036” organization has launched a groundbreaking, multi-year study to find out why millions of Texans remain uninsured. The Texas 2036 study seeks to create a more holistic understanding of Texas’ uninsured population — the largest in the country — and to better identify barriers and personal decisions that result in Texans not having access to affordable care. Learn more about the study and the work of Texas 2036 here.

Improving the Health of Texas

admin — Mon, 12 Apr 2021 21:22:00 +0000

Our updated overview of health coverage, care, and costs is available for download. It includes “7 Steps to a Comprehensive Texas Solution” for covering all Texans with access to care.

Health-Healthcare-Insurance-for-Rice-031821-1 Download

Opinion: Texas can’t afford to pass on Medicaid expansion

Wild Blue — Wed, 31 Mar 2021 21:52:00 +0000

It doesn’t get clearer than this: expanding Medicaid strengthens the Texas economy, improves Texans’ health, and benefits people and companies all across the state, in rural and urban areas. Please read more from Elena Marks of Episcopal Health Foundation, in the Houston Chronicle.

EHF recently published a poll showing sweeping support among Texans for Medicaid Expansion. You can review the survey here.

A Biden win sows hope in health care sector

admin — Tue, 10 Nov 2020 21:17:00 +0000

For Houston hospitals and the region’s health care industry, a Biden presidency could bring more economic relief for medical providers that have struggled under the costs of COVID-19 care and more stability to health care policy, which became uncertain under Trump, said Ken Janda, a former insurance executive and adjunct professor of health policy management at Rice University.

“The markets are all assuming nothing terrible is going to happen to the Affordable Care Act and Congress is not going to be able to mess with it much,” Janda said “Now that Biden has been elected, that has eliminated uncertainty.”

Read the rest of this story in the Houston Chronicle

Will individuals see the savings from insurance pandemic relief? Not quite

Wild Blue — Thu, 15 Oct 2020 15:42:56 +0000

In a conversation with Houston Chronicle reporter Gwendolyn Wu, Wild Blue’s founder Ken Janda noted that insurers must guess whether it’s a better financial move to reimburse customers now in the form of premium credits, or to wait until next year and see if there’s pent-up demand from people who put off care in 2020.

“All of those services are down and save the insurance company money this year because they don’t have to pay those claims, but could potentially cost them money next year or the year after,” Janda said.

Read the full story here, including additional insights from Wild Blue Health Solutions.

Forbes: Is There A Better Way To Subsidize Private Health Insurance?

Ken Janda — Fri, 31 Jul 2020 15:19:56 +0000

Intro from Ken: Following is an opinion column from Forbes.com, a health policy assessment of Medicare Advantage from Contributor John C. Goodman.

Mr. Goodman doesn’t fully endorse the solution of Medicare Advantage for All, but he provides some interesting thinking around the parameters for solving the question of how do we cover all Americans with access to care in ways that are affordable and reasonable?

https://www.forbes.com/sites/johngoodman/2020/07/30/is-there-a-better-way-to-subsidize-private-health-insurance/#fe31fd4a524f

Keckley on: Medicare Advantage “for all”

Ken Janda — Tue, 21 Jul 2020 14:45:50 +0000

Is Medicare Advantage Part of the Solution or Part of the Problem?

July 20th, 2020

By Paul Keckley of The Keckley Report

Intro from Ken: As I continue to assess health coverage options for America, the Medicare Advantage system continues to emerge as a strongest, broadly integrated, and potentially broadly trusted solution. I’m glad to see this piece from Paul Keckley, quoted in its entirety below.

Medicare Advantage (MA) has been an option for seniors since 2003. By all accounts, it’s doing well:

According to the Medicare Alliance, an advocacy group supportive of MA “With a record-setting 99 percent satisfaction rate, an average $1,598 cost savings as compared to Traditional Medicare, demonstrably better health outcomes, and support from a bipartisan supermajority of 403 members of the U.S. House of Representatives and Senate, we at Better Medicare Alliance can say with certainty that the state of Medicare Advantage is strong.”

That’s the bet traditional health insurers like United, Humana and Aetna, upstarts like Bright Health, Clover and Devoted and primary care start-ups like Oak Street and ChenMed are making. The numbers favor their bet: the senior market is growing: the number of seniors 65-plus will increase 30% to 73 million by 2030 and 70% to 95 million by 2060. And Medicare Advantage is expected to increase its proportionate share of this $400 billion market annually for the foreseeable future achieving 50% market penetration by 2030 if not sooner.

Today, Medicare Advantage plans enroll 24.2 million seniors, or 43%. The average senior has almost 40 plans from which to choose: the average monthly premium is around $23 which makes it attractive to price conscious seniors. And CMS has authorized plans to add supplemental benefits like vision and dental care and over the counter therapies to stimulate competition.

Thus, Medicare Advantage seems a solution to two major problems in the U.S. health system: slowing the rate of Medicare spending to extend its solvency beyond 2026, and shifting incentives from fee for service to value-based arrangements with providers to improve care coordination.

My Take

Is MA the solution to the future for Medicare and a template for improving the effectiveness of the health system? Maybe, but it’s not without challenges that require attention from its proponents:
Risk scores and Star Ratings: As it turns out, the risk scoring methodology by which the clinical complexity of a plan’s enrollees is assessed is being scrutinized by the feds who suspect some have overstated the complexity of their enrollees to get a higher PMPM payment from Medicare. And the Star Ratings on which 5% bonus payments are based do not appear to make consumer comparison shopping more meaningful.52% of plans have a rating of 4 or higher; the average star rating for 2020 is 4.16 vs. 4.06 in 2019 and 4.02 in 2017 and 81% of seniors are covered through a Four-Star plan. So, Star Ratings are more useful to enrollees in eliminating plan options than picking one based on performance.
Enrollee Acquisition: Thus far, MA enrollment has been straightforward: effective ads and boots on the ground are table stakes. Most seniors do not move from MA plan to MA plan, so recruiting an enrollee means recurring revenue for plan sponsors. But enrollment in middle and higher income senior cohorts has been problematic: their preferences for traditional Medicare fee-for-service are deeply rooted in specific clinicians (in network coverage) and the availability of supplemental (gap) insurance to cover what’s not covered by Medicare.Both are manageable but assure heightened attention by regulators as Medicare Advantage plans compete.

I think the likelihood that Medicare for All, in whatever form, will replace the U.S. pluralistic public-private payment system is low. It will continue to be debated but the public’s lack of confidence in the federal government remains problematic.

Might Medicare Advantage for All be the alternative? I suspect so, but not without significant alterations in plan design to improve their clinical effectiveness and value proposition for enrollees and additional savings for Medicare. And the Biden campaign’s pledge to lower the age of Medicare eligibility to 60 makes the discussion even more intriguing since life expectancies extend to 80 for many.

Paul

P.S. This week, Congress will debate a relief package for hospitals, small business, and many of the 20 million individuals who lost their jobs. Temporary unemployment benefits for many expire next week, so partisan bickering will no doubt take this legislation down to the wire.

Resources

“Three Reasons Medicare Advantage (MA) is a Viable Framework for America’s Health System: A Strategic Perspective” https://www.paulkeckley.com/the-keckley-report/2019/7/7/three-reasons-medicare-advantage-ma-is-a-viable-framework-for-americas-health-system-a-strategic-perspective-sbhf6?rq=medicare%20advantage

“State of Medicare Advantage: July 2020” Better Medicare Alliance https://www.bettermedicarealliance.org

Nicholas Florko “The CDC has always been an apolitical island. That’s left it defenseless against Trump” STAT July 13, 2020 https://www.statnews.com/2020/07/13/cdc-apolitical-island-defenseless

Frieden “Medicaid Programs Adjusting to Change During the Pandemic” MedPage Today July 15, 2020; https://www.medpagetoday.com/infectiousdisease/covid19/87587

U.S. Health Care Financing (Residency Program)

Marie Nury — Tue, 12 May 2020 17:06:01 +0000

You are welcome to download the U.S. Health Care Financing presentation presented to the Lone Star Family Health Center Residency Program to learn about key concepts for an informed health care conversation.

Health Care Financing – Lone Star Family Health Residency Program Download

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Featured Article: “We need to expand Medicaid in Texas now” by Sen. Nathan Johnson

Ken Janda — Sat, 11 Apr 2020 15:23:09 +0000

This article originally appeared in the Dallas Morning News Opinions section on April 8, 2020:

We need to expand Medicaid in Texas now

Public opinion now supports the shift, and there’s federal money to pay for it.

The conventional political wisdom has been the same for Republicans and Democrats: Don’t say Medicaid expansion. I suppose that explains the nervous chuckling I used to hear when I kept giving the same answer to different questions: How can we help our millions of uninsured citizens? Expand Medicaid. What can we do to stimulate the Texas economy? Expand Medicaid. How do we raise state revenue without raising taxes? Expand Medicaid.

Much has changed in the past few years. Medicaid expansion is now politically popular in Texas, and a time-tested success across the nation. But the political inertia persists, and Texas remains one of only 14 states that haven’t implemented some form of Medicaid expansion.

COVID-19 brings a new urgency to the matter. Medicaid expansion would not only provide care to those most in need but would also help us combat the contagion and provide powerful economic stimulus when we need it more than ever.

It’s time for Gov. Greg Abbott to use his executive authority to expand Medicaid in Texas, now.

Consider the need even before COVID-19. Among the 50 states, Texas has the highest number and percentage of uninsured citizens. Some 1.5 million of the uninsured fall into the expansion gap, earning too much to qualify for Medicaid but too little to qualify for federal insurance subsidies. Their lack of access to health care harms all of us, by increasing the burden of uncompensated care, driving up health care costs, overcrowding emergency rooms, and lowering the state GDP. On the fiscal side, starting next year Texas stands to lose billions of (our own) federal tax dollars when our current non-expansion deal expires and new federal regulations drastically undercut the patchwork system we use to pay for indigent health care.

In contrast, numerous studies have shown that expansion states have seen improved health, increased use of primary care, decreased use of emergency care, lower smoking rates, higher employment rates, improved family financial stability and sustained operation of rural hospitals. On the fiscal side, economist Ray Perryman estimates that expansion would bring about $8 billion into the Texas economy annually, increase gross state product by $29.4 billion over just the first two years, generate a 331% return on investment over 10 years, and have a net positive effect on the state budget.

The COVID-19 crisis has magnified both the needs and the benefits associated with expansion. Workers in the service sector have lost their jobs and as a result lost their insurance. Many among our essential workforce — front-line health care workers, grocery store clerks, drivers and many others — have never been able to afford health coverage in the first place. We should all take pride in providing them with access to care. Meanwhile, social restrictions aimed at protecting life and preserving hospital capacity show the need to accelerate deployment of telemedicine services, and to be able to track, treat, quarantine and isolate. Medicaid expansion serves these ends.

As the 37th state to expand Medicaid, Texas wouldn’t be venturing into uncharted territory. In fact many Republican-led states have expanded Medicaid. Indiana did under then-Gov. Mike Pence. Ohio, Arizona, Indiana and others were able to use expansion to reform and improve their existing Medicaid programs, adding conservative favorites such as health savings accounts, behavior incentives and changes to delivery systems.

There’s no avoiding the expansion conversation any longer. It can’t be brushed aside by saying, “I’m waiting for a block grant.” The Trump administration just offered block grants. (Many, including me, believe that a block grant isn’t the best vehicle, but it’s still Medicaid expansion.)

And early conservative questions and doubts have been answered and dispelled by the positive results in the 36 other states that expanded Medicaid by standard means. Although differences between states do matter, the federal government has made clear that Texas will enjoy unprecedented flexibility in crafting a plan that accommodates its unique needs.

Supporting expansion now is not flip-flopping; it is altering strategy in response to better information and different circumstances. Today we have overwhelming public and business support, successful conservative models, greater flexibility, an even higher level of need, profound urgency and, as part of the federal COVID-19 crisis response, billions of federal dollars that can be employed to ensure that Medicaid expansion in Texas is a fiscal and health care success.

Only the governor can expand Medicaid immediately. Successful implementation over the long term, however, will require both Republicans and Democrats to recognize that Medicaid expansion is a vital and effective means to address our most urgent economic and health care challenges. And that it’s OK to say it.