FirstCare Health Plans Bringing Medicare Special Needs Plan to West Texas

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AUSTIN, Texas, Dec. 4, 2018 — Today, officials at FirstCare Health Plans announced the new FirstCare Advantage Dual SNP (HMO SNP) plan, which is back after a brief absence, and available in the Lubbock and Amarillo communities.

The plan is designed to meet the special needs of those with Medicare and Medicaid. They must be eligible for both Medicare and Medicaid in order to enroll in FirstCare Advantage Dual SNP, and they must reside in one of the following Texas counties: Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher, and/or Terry.

“We are excited to introduce a new plan for 2019—FirstCare Advantage Dual SNP for Medicare beneficiaries with both Medicare and Medicaid,” said FirstCare Assistant Vice President of Government Programs Danielle Jaber. “At FirstCare, we’ve been helping Texans cut through health care confusion for over 30 years. We’re proud to be a part of the communities we serve, and we believe all Texans should have access to affordable, high-quality health care.”

For 2019, beneficiaries will be able to access a number of programs that enhance the care and services covered under the FirstCare Advantage Dual SNP plan. These include assigning dedicated case managers to members who need help accessing care, providing education and support to members who have certain chronic conditions, connecting members to a pharmacist who helps them manage their medicines, accessing telemedicine services via FirstCare Virtual Care—powered by MDLIVE, and providing a free phone service for members that allows them to talk with a nurse about their health concerns—24 hours a day, seven days a week.

Medicare beneficiaries can enroll in FirstCare Advantage Dual SNP during the federally regulated Annual Enrollment Period (AEP) from October 15, to December 7, 2018, with benefits effective January 1, 2019. Certain circumstances allow for enrollment throughout the year, outside of AEP. For more information, prospective members are encouraged to call 1-866-229-4969 (TTY users call 1-800-562-5259), October 1 – March 31, 8 a.m. – 8 p.m. Central Time (CT), daily; April 1 – September 30, 8 a.m. – 8 p.m. CT, Monday – Friday. They can also write to:  FirstCare Advantage Dual SNP (HMO SNP); Attn: Customer Service; 1901 W. Loop 289, Suite 9; Lubbock, Texas 79407. If you speak Spanish, language assistance services are available to you. Si usted habla español, tenemos servicios de asistencia de idiomas disponibles para usted.

FirstCare Advantage Dual SNP (HMO SNP) is a Health plan with a Medicare contract and a contract with the Texas Medicaid program. Enrollment in FirstCare Advantage Dual SNP (HMO SNP) depends on contract renewal.

About FirstCare Health Plans
At FirstCare, our mission is to work together to serve our customers and build healthier communities—one member at a time. Since 1985, we’ve been serving the health care needs of members across North, West, and Central Texas. Today, our service area includes 143 counties, with local offices in Abilene, Amarillo, Lubbock, and corporate offices in Austin, Texas. We offer a wide range of HMO, PPO, HSA, and ASO products through a variety of programs, including small and large employer plans; state, federal and teacher plans; government programs; and the Health Insurance Marketplace. With the support of our owners, Covenant Health in Lubbock and Hendrick Health System in Abilene, we serve over 150,000 members. For more information, please visit FirstCare.com.

Obamacare sign-ups set to begin for 2019

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Local advocates get word out as Obamacare sign-ups set to begin for 2019

Open enrollment for 2019 health insurance under the Affordable Care Act is about to kick off — as is the annual effort by local health care advocates to overcome a fresh crop of challenges that could deter people from signing up.

Beginning Thursday and running through Dec. 15, subsidy-eligible insurance plans are available on the federal marketplace — HealthCare.gov — that will provide health coverage starting Jan. 1. Four companies are offering plans in the Austin area for 2019, the same as this year.

The United Way for Greater Austin, with support from Travis County’s health district, is providing a call center for information and assistance during the upcoming enrollment period for people who want coverage. To access the service, area residents can dial 211 on their telephones.

The biggest change for 2019 to the Affordable Care Act — commonly known as Obamacare — is that those who opt to forgo health insurance altogether won’t be required to pay a tax penalty.

Republicans in Congress, who have been seeking to weaken the Affordable Care Act after failing to repeal it, approved tax legislation in 2017 that abolishes the fine beginning next year. President Donald Trump — an opponent of the Affordable Care Act — signed the measure.

“Historically, there has been a carrot and a stick” to persuade people without health insurance to sign up for coverage, said Elizabeth Krause, senior program officer in charge of health insurance enrollment at St. David’s Foundation. “We have lost the stick in terms of the tax penalties, but the carrot still exists” because subsidies for health insurance remain available.

St. David’s Foundation, a philanthropic entity funded through its co-ownership of the hospital, plans to spend $500,000 this year — up from about $300,000 last year — to publicize open enrollment and to support community groups that help people sign up for coverage. Krause said the extra spending is aimed at partially offsetting new cuts this year to federal funding for such efforts.

“We’re getting the word out that the Affordable Care Act still exists and there is help enrolling for people who need assistance and there are still discounts available,” Krause said.

But the lack of a penalty for 2019 could nonetheless prompt some people to forgo insurance, which health care advocates fear will leave them financially vulnerable if they suffer unforeseen health problems. If large numbers of relatively young and healthy people decide not to sign up, it also could begin to destabilize the Obamacare insurance marketplace by skewing enrollment too far toward those who are older, sicker and have higher medical bills.

Other recent changes by the Trump administration also could lead to lower Affordable Care Act enrollment.

Federal funding has been reduced for the second year in a row for organizations that help people evaluate their Affordable Care Act options and enroll in coverage. In Texas, the federal money has been cut from $6.1 million last year to about $1.4 million — and none of it is going to groups working in the Austin metro area.

In addition, the administration has cleared the way for the eventual sale of more short-term health insurance policies that don’t have to comply with the Affordable Care Act’s minimum requirements, including coverage of pre-existing conditions. Opponents contend these policies could confuse consumers and leave those opting for them over Obamacare-compliant plans with unpleasant surprises if they haven’t familiarized themselves with the fine print.

“There have been attempts at the federal level to erode the marketplace and really chip away at the viability” of the Affordable Care Act, said Kay Ghahremani, chief executive of the Texas Association of Community Health Plans. The tax penalty in particular “really was a foundation (of the law), and no one knows exactly how (enrollment) is going to play out” without it.

Still, Ghahremani and other health care advocates are taking some solace from open enrollment last year, when a variety of moves by the Trump administration that were viewed as attempts to undercut the Affordable Care Act failed to result in big declines in sign-up numbers.

Last year’s enrollment period for 2018 coverage was cut in half — to six weeks, the same as this year — but sign-ups still reached 97 percent of the previous total nationally and about 92 percent of the previous total statewide.

In the Austin metro area — including Travis, Williamson, Hays, Bastrop, Caldwell and Burnet counties — combined enrollment for 2018 coverage came in at about 93,000 people, or about 85 percent of the previous year. Enrollment was 58,557 in Travis County, 20,660 in Williamson County and 7,817 in Hays County.

“There is a risk (that enrollment numbers could drop this year), but I don’t think the penalty was the biggest driver” fueling sign-ups, Ghahremani said. “There is a lot of evidence that people want health insurance, and there is so much need” for it.

In Texas, the state’s nation-leading rate of uninsured people is evidence of the potential demand. About 17.3 percent of Texans lacked health insurance in 2017, according to the U.S. Census Bureau, a figured that inched up from 16.6 percent in 2016 after declining from just above 22 percent in 2013 — the year before Affordable Care Act coverage took effect.

Kori Hattemer, director of financial programs for local nonprofit Foundation Communities, said she’s optimistic as the start of open enrollment nears. Foundation Communities, which receives funding from St. David’s Foundation, is training upwards of 100 volunteers to help people sign up for coverage.

“There are challenges every year,” Hattemer said. “But we have incredible local support, and the people we work with want to have health insurance and they see the value of having health insurance — with or without a mandate.”

As reported by the Statesman https://www.statesman.com/news/20181027/local-advocates-get-word-out-as-obamacare-sign-ups-set-to-begin-for-2019

SCOTT AND WHITE HEALTH PLAN TO ACQUIRE FIRSTCARE HEALTH PLANS

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SCOTT AND WHITE HEALTH PLAN TO ACQUIRE FIRSTCARE HEALTH PLANS

DALLAS, TEXAS (Oct. 23, 2018) – Scott and White Health Plan, part of Baylor Scott & White Health, has signed a definitive agreement to acquire FirstCare Health Plans.

This acquisition will allow the two provider-owned health plans to come together to create a more comprehensive and sustainable insurer with a driving focus on enhancing the customer experience through advanced technology.

“For more than 35 years, Scott and White Health Plan has served Central Texas and surrounding communities,” said Jeff Ingrum, CEO of Scott and White Health Plan. “Uniting our health plans will allow us to ensure the long-term viability for both, continuing our histories of Texans serving Texans.”

Collectively, the plans cover nearly 400,000 members. Once finalized, the acquisition will mean for those members an expanded network of providers in the communities the health plans serve.

“We are confident this is in the best interest of our members, providers, agents and employees,” said Darnell Dent, President and CEO of FirstCare Health Plans. “I am proud of FirstCare’s legacy of excellence, compassion and high-quality service to our communities in North, West and Central Texas. We are looking forward to advancing that legacy.”

The definitive agreement signed by Scott and White Health Plan and FirstCare Health Plans’ owners, Covenant Health System and Hendrick Health System, is now subject to regulatory approval. Pending that approval, the acquisition is expected to be finalized in early 2019.

It is important to note that nothing changes for members or employees of either health plan today.

For more information on Scott and White Health Plan, visit: SWHP.org. For more on FirstCare Health Plans, visit: FirstCare.com.

About Scott and White Health Plan
At Scott and White Health Plan, our mission is to be the most trusted name in giving and receiving safe, quality, compassionate healthcare. As the #1 rated private health insurer in Texas, we are proud to increase access to high-quality, coordinated patient care for more than 220,000 of our friends, families and neighbors in 80 counties across Central, East, North, and West Texas. For more information on our innovative, integrated delivery capabilities, quality programs that drive savings and best-in-class member experience, visit SWHP.org.

About FirstCare Health Plans
At FirstCare, our mission is to work together to serve our customers and build healthier communities— one member at a time. Since 1985, we’ve been serving the health care needs of members across North, West, and Central Texas. Today, our service area includes 143 counties, with local offices in Abilene, Amarillo, Lubbock, and corporate offices in Austin, Texas. We offer a wide range of HMO, PPO, HSA, and ASO products through a variety of programs, including small and large employer plans; state, federal and teacher plans; government programs; and the Health Insurance Marketplace. With the support of our owners, Covenant Health in Lubbock and Hendrick Health System in Abilene, we serve over 160,000 members. For more information, please visit FirstCare.com.

Why is Texas suing to strike down Obamacare?

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“Your honor, I’m suing my family today to force them to accept my list of vacation locations. A second lawsuit will hold my church accountable for services exceeding one hour. I anticipate several amicus briefs.”

Living by filing lawsuits seems crazy, doesn’t it? As adults we should have reasonable discussions with others to explore choices and resolve disagreements outside the court system, right?

Try telling this to the State of Texas, which has sued the federal government more than 50 times in the last 10 years at a taxpayer cost exceeding $15 million. Texas just spent $7 million on a years-long lawsuit because they didn’t want to air condition a state prison in which inmates had died from the heat. The kicker, at least financially? Texas could have saved $3 million of our taxpayer dollars fixing the problem. Texas has sued against clean air and clean water regulations, immigration policies, health insurance, voting rights — and the list unfortunately goes on and on.

Please read compeltestory in the Houston Chronicle https://www.houstonchronicle.com/local/gray-matters/article/texas-obamacare-lawsuit-13204630.php

Medicaid is working for Texas families

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With a poverty rate of 48.8%, Fabens is the poorest town in Texas and it’s the only town where more than half of households live on less than $25,000 a year. Fabens is home to closely 10,000 men, women and children, of which 80% receive their health coverage through Medicaid.
In 2010, one of the last Kellogg Community Partnership (school based) Clinics in the El Paso area closed its doors. Without that nearby clinic, impoverished Fabens families had limited access to health care. Without a single bus line servicing Fabens, residents found traveling to access health care was grueling.

In 2012, I established the only private, stand-alone, family medical clinic in Fabens. It functions as a result of our partnership with El Paso Health who contracts with the state to manage Medicaid in our region. President and CEO Frank J. Dominguez makes personal visits to doctor’s offices. Dominguez and I believe it is critical to provide customized clinical services, according to the community needs, and to support the way Texas runs Medicaid using the managed care model.

This approach allows plans, such as El Paso Health, the flexibility to develop unique programs. Annually, they organize healthy Thanksgiving dinners and provide back-to-school backpacks loaded with school supplies.

We invest Medicaid funds in the latest technology for screenings and other preventive equipment enabling clinic efficiencies. For example, we have the ability to perform an in-office EKG and confidently assure a mother that her son’s heart is performing well, easing her mind while preventing an unnecessary hospital visit.

Our approach also means working beyond typical office hours. Fabens patients know that they can knock on my door, even after 5 p.m., and I will see them. It means sharing my cell phone number with patients and driving to meet a family in a shopping mall parking lot on a Saturday for a child that needs stitches.

Our specialist partners also open their doors so our patients avoid costly ER and hospital visits.

Today, these investments and modifications have paid off. Our clinic is one of the highest-ranked for meeting critical state standards for preventive health care and pediatric checkups called Texas Health Steps. For my patients, the number of ER visits that could have been prevented, a common measure used by the state and El Paso Health to determine outcomes, is by far the lowest rate in El Paso, and one of the lowest in Texas. Our clinic costs are also some of the lowest in the entire state Medicaid program, making our partnership a win for both patients and taxpayers.

As Texas legislators examine the effectiveness of the family medical clinic in Fabens, we, together with El Paso Health, want them to understand what we know firsthand. Medicaid is working for Texas families. We call on state leadership to continue to support the Medicaid so that clinics like the one in Fabens thrive.

Dr. Ulysses Urquidi operates the only private family medical clinic in Fabens.

Your Turn

Ulysses Urquidi Guest columnist

New lives, bright futures in South Texas

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As a pediatric anesthesiologist in South Texas, I have logged countless hours in operating rooms caring for babies who have undergone multiples surgeries — some in the moments after birth. These have been some of the most heartbreaking moments of my life. Sadly, many of these surgeries could have been prevented if someone had stepped in and provided support to the expectant mothers, taking their hand and walking them through the steps of a healthy pregnancy and delivery, as well as providing special help in complicated preg-nancies.

Much of what I witnessed was under the old way that Texas ran its Medicaid program — the fee-for-service model. Under this approach, the state paid doctors and other providers for the quantity of services they provided — not the quality of those services. Care was fragmented. Ultimately Texas moved to today’s model — the managed care approach — in which the state partners with private health insurers who have the tools and expertise to boost quality while keeping costs affordable. This modern approach lends itself to more flexibility and more creativity, which has led to coordinated care and a focus on prevention. Over the years, both as a physician and today as an administrator with our Medicaid plan, Driscoll Health Plan, I have seen a slow but steady transformation of the Medicaid program in Texas. A snapshot of that transformation is the incredible gains we have made for mothers and babies in South Texas.

Read original story as published by The Monitor http://www.themonitor.com/opinion/columnists/article_b164dd98-5ae3-11e8-baef-db7733dbec4f.html

Legislators need to back Texas Health and Human Services Commission

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Legislators need to back Texas Health and Human Services Commission

By Ken Janda

Have you followed much news coverage of our Texas Health and Human Services Commission ? In the midst of escalating concerns and long-running criticism, some valid and some not, what might surprise you the most is learning the Health and Human Services Commission of the state of Texas runs the best Medicaid operation in the country — despite being a gigantic, wide-ranging organization charged with helping often overlooked poor and frail Texans; despite being underfunded year after year, and despite sometimes serving as a whipping post for policymakers.

In spite of contracting mix-ups and executive resignations, the faithful public employees at HHSC have inaugurated and overseen Medicaid Managed Care contracts saving Texas taxpayers $4 billion since 2010, as compared with the old fee-for-service system. Health care leaders from other states visit Texas to learn from our success how they might set up a similar system.

Now another high-profile departure is looming: Charles Smith, executive commissioner, will leave at the end of May. Smith is one of six HHSC officials to resign recently, among the dozens of experienced senior leaders who have departed in the last several years.

Former Republican state Sen. Tommy Williams, who represented District 4 in the Woodlands in Montgomery County, has been tapped as the short-term fix-it guy, to find out what went wrong and set the Health and Human Services Commission — with all its divisions and agencies —on the right path.

Regardless of what Smith has done well, or not well, simply setting up new management or more careful contract oversight is a little like renovating the kitchen of a Texas Gulf Coast house before the next hurricane season. That better, more efficient kitchen is not going to protect the house from an environment of rising water or raging storm surge, otherwise known as legislative actions that seem to make it harder for HHSC to serve those in need.

Can Williams persuade his former colleagues in the Legislature to appropriately fund the work of HHSC? Can Williams help the statehouse further embrace the mission of caring for children, elderly Texans and vulnerable people throughout our state? If he can’t redirect a storm surge of program bashing, an internal HHSC reorganization isn’t going to help much.

Certainly, reforms are needed at HHSC. This department charged with oversight of 100,000-plus contracts worth more than $60 billion needs experienced, trusted staff able to manage large contracts. It needs a more robust culture of accountability and respect. But more than anything else, HHSC needs the moral support of legislators and state leaders who believe in the mission, support the people and celebrate the results.

What is the mission, what are the results? HHSC encompasses the human condition in Texas, from pregnant mothers and babies and hurricane help to vulnerable senior citizens and food benefits. Looking at the Medicaid program alone, the per capita cost of the Medicaid Managed Care program in Texas has grown by only 1 or 2 percent annually for the last 15 years. This incredibly low cost is less than the Consumer Price Index, and much less than the cost of Medicare or employer-sponsored insurance, including the cost of health insurance for state employees, municipal employees and teachers throughout the state. Medicaid serves mostly children, aged and disabled residents, and it protects the lives of the unborn through funding maternity care for low-income women. While achieving all of these successes, this single HHSC program has saved Texas more than $4 billion since 2010.

At the same time, access to care in Medicaid has never been better, continues to improve and customer satisfaction is better than for employer-sponsored insurance. Health outcomes for women, children and the disabled are all improving. Children on Medicaid now have access to care, pediatric well-child visits and immunization rates as good as commercially insured kids.

Yes, there is much work to do to improve the lives of those who depend on Medicaid and to find ways to expand this Texas success to others in need. Yes, HHSC needs fresh direction and that starts with investment from our state leaders. In this case, Texas doesn’t need less government, it needs better governance. Unfortunately, it is too late for.Charles Smith, and if our state keeps going this route, piling on HHSC will drive out the remaining wonderful employees who work there. Losing our experienced public servants hurts Texans from the cradle to the grave.

It’s time for our elected officials to invest wholeheartedly in the work of HHSC, and this starts with telling the great story of the successful Medicaid program in Texas.

Janda (@HealthyTexans) is president and CEO of Community Health Choice Inc. (Community), a Houston-based, nonprofit managed care organization that provides innovative health insurance plans focused on low-income families. He also teaches health policies as an adjunct professor in the Jones Business School at Rice University.

Read original story as published by the Houston Chronicle https://www.houstonchronicle.com/opinion/outlook/article/webhead-webhead-12898484.php

MARCH OF DIMES PARTNERS WITH 2-1-1 TEXAS CITY OF EL PASO

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MARCH OF DIMES PARTNERS WITH 2-1-1 TEXAS CITY OF EL PASO TEXAS DEPARTMENT OF PUBLIC HEALTH AND EL PASO HEALTH TO LAUNCH

GO BEFORE YOU SHOW

(El Paso, TX, May 8, 2018)— March of Dimes has partnered with 2-1-1 Texas, City of El Paso Texas Department of Public Health and El Paso Health to launch “Go Before You Show,” a public education campaign that encourages women to seek medical care as soon as they think they are pregnant. This program will provide local social service agencies with a variety of resources in the form of posters, flyers and additional community support systems through the 2-1-1 Texas Helpline in order to educate women on the importance of prenatal care during their first trimester of pregnancy. This campaign is one of many that March of Dimes supports in pursuit of its mission to lead the fight for the health of all moms and babies.

From 2011 through 2014 in El Paso County, only 64% of pregnant women received prenatal care during their first trimester. Women who see a health care provider regularly during pregnancy have healthier babies, are less likely to deliver prematurely, and are less likely to have other serious problems related to pregnancy. When seen early in a pregnancy, providers can identify social issues and medical conditions and take steps for treatment and risk reduction.

Interested partnering agencies are invited to the “Go Before You Show” Community Launch on Tuesday, May 15, 2018, at El Paso Health, 1145 Westmoreland Dr. at 11:30am. Agencies can RSVP to Amy Johnson-Rubio, Maternal and Child Health Director, at ajrubio@marchofdimes.org or 806-686-0307. At the launch, agencies may pick up their free educational materials to be used with their clients. Agencies will collaborate with the March of Dimes “Go Before You Show” campaign to increase the chances of meeting organizational goals of providing women who believe they might be pregnant with health-related resources during their first trimester of pregnancy.

March of Dimes leads the fight for the health of all moms and babies. It supports research, lead programs and provides education and advocacy so that every baby can have the best possible start. Building on a successful 80-year legacy of impact and innovation, the March of Dimes empowers every mom and every family. Visit marchofdimes.org or nacersano.org for more information. Visit shareyourstory.org for comfort and support. Find them on Facebook and follow us on Instagram and Twitter.

The 2-1-1 Helpline provides free information and referral assistance using the most comprehensive database of social services in the community. 2-1-1 Helpline specialists are available around the clock, providing help and hope for so many women who are facing major challenges. They are a critical link to vital social service resources. No matter the problem, day or night, every day, all day, the 2-1-1 Helpline is standing by to help.

GO BEFORE YOU SHOW
El Paso Health is a local, private, non-profit organization. It is a Texas-licensed health maintenance organization (HMO) established by the El Paso County Hospital District to enter into contract with the Health and Human Services Commission (HHSC) for the purpose of improving access to medical care for STAR and CHIP members in El Paso and Hudspeth Counties.

FOR MORE INFORMATION CONTACT: Amy Johnson-Rubio, 806-686-0307

Obamacare sign-ups slip in Austin area; strong economy likely a factor

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Obamacare sign-ups slip in Austin area; strong economy likely a factor

Area health care advocates say they are pleased with enrollment numbers.

By Bob Sechler – American-Statesman Staff

Enrollment in health insurance plans for 2018 under the Affordable Care Act slipped from 2017 in the Austin metro area but still reached about 85 percent of last year’s total, despite a sign-up period that was half as long and widespread confusion over the fate of the law.

Statewide, enrollment came in at about 92 percent of the 2017 number, according to the federal Centers for Medicare and Medicaid Services, while nationally it came in at 97 percent of last year.

Some health care advocates said the strong local economy likely played a role in the Austin area’s lower sign-up percentage for 2018 compared with the state and national performances, because more people might have had access to health insurance through private employers here. Regardless, they called the figures strong overall.

“I think insurers were surprised at how positive these enrollment numbers were,” said Kay Ghahremani, chief executive of the Texas Association of Community Health Plans. “The numbers show that people want health insurance and there is still a great need for it.”

The Centers for Medicare and Medicaid Services released the final 2018 enrollment figures this week for the 39 states — including Texas — that use the health insurance marketplace run by the federal government, called HealthCare.gov, as well as for the 11 states that operate their own marketplaces.

The agency provided preliminary sign-up totals in December for the 39 states using HealthCare.gov, although no county-level figures were available then, nor was the data from the 11 additional states

Proponents of the Affordable Care Act, commonly referred to as Obamacare, faced significant challenges during the enrollment period for 2018 health coverage, and many feared sign ups would fall precipitously.

President Donald Trump has repeatedly criticized the law — one of the signature accomplishments of his predecessor, former President Barack Obama — and Republicans in Congress have repeatedly tried, and failed, to repeal it. Meanwhile, the Trump administration reduced the enrollment period to 45 days, from three months, for the states using HealthCare.gov, while also sharply cutting money to advertise it and to pay for assistance to help people evaluate options.

Despite those moves, national enrollment for 2018 was off by only about 3.3 percent, or 400,000 people, coming in at about 11.8 million, according to the figures released this week. Statewide, enrollment in Texas was off about 8 percent, or about 100,000 people, at 1.13 million.

In Austin-area counties — including Travis, Williamson, Hays, Bastrop, Caldwell and Burnet — combined enrollment for 2018 came in at about 93,000 people, down about 15,400 from last year, or 14 percent. Enrollment in Travis County came in at 58,557, off 14 percent from last year, while Williamson County sign-ups totaled 20,660, down about 13.5 percent.

Health care experts said it was not a surprise that the statewide number declined by a larger percentage than the national figure, saying Texas was among the states that did little to make up for the Trump administration’s reductions in advertising and assistance.

Texas “took as hands-off an approach as it could,” said Stacey Pogue, a senior policy analyst for the Austin-based Center for Public Policy Priorities, a left-leaning think tank. “We as a state didn’t prioritize trying to overcome all of the barriers, and some other states did.”

Locally, observers said the strong economy was partially responsible for the bigger regional enrollment slump than was seen statewide or nationally, as was the fact that some premium tax credits available in the Austin metro area weren’t as large as in other regions, rendering certain plans more expensive for consumers.

Overall, though, the 2018 enrollment figures were heralded by Affordable Care Act proponents, who said insurance companies likely will view the trend as a bullish signal that demand for health plans under Obamacare remains robust going forward.

“That we were able to closely maintain the numbers is a good sign for the future of the marketplace,” said Elizabeth Colvin, director of the Insure Central Texas program at Foundation Communities. “I am very happy with the numbers, given the many challenges that this enrollment period faced.”

Colvin said her organization, which focuses on the segment of consumers who need assistance enrolling or have complex medical needs, successfully helped 5,336 people sign up for 2018 health plans, exceeding last year’s total by 22 percent in half the time.

As published by the Austin- American Statesman https://www.mystatesman.com/lifestyles/health/obamacare-sign-ups-slip-austin-area-strong-economy-likely-factor/dRKbsGhUY0ucuR8SkxS1eK/

Evaluating the Cost-Effectiveness of Medicaid Managed Care

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Evaluating the Cost-Effectiveness of Medicaid Managed Care

The Texas Legislature first began utilizing Medicaid managed care in the early 1990s. What began as a small regional Medicaid managed care pilot in 1993 has today grown to operate in all of Texas’s 254 counties and cover over 90% of the state’s Medicaid enrollees.1 Medicaid Managed Care Organizations (MCOs) are paid billions of taxpayer dollars on an annual basis to care for some of the state’s most complex and vulnerable populations. The level of trust and responsibility placed within these plans, as well as the state’s significant investment in this model, raises the valid question of whether Medicaid managed care has continued to provide a sound return on investment, both in terms of costeffectiveness and quality of care. While this question is a very reasonable one to posit, arriving at a quantitative value by which to judge the success of Medicaid managed care is difficult, as determining a baseline for which to compare “would-be” fee-for-service (FFS) Medicaid costs and outcomes becomes problematic. Because Texas has been using the Medicaid managed care model for so long, its savings and efficiencies are assumed within the Medicaid program’s budget, thus making it problematic to determine what costs would have been under FFS.

To help analyze available data and verify the cost-effectiveness of the Texas Medicaid managed care model, the Texas Conservative Coalition Research Institute (TCCRI) procured the services of Carruth & Associates, an independent outside firm headed by the former Chief Financial Officer of HHSC. These findings are presented in their entirety in Appendix A.

While that report, and this paper, will focus primarily on cost savings associated with Medicaid managed care, this model has also shown great success in raising the quality of care for Medicaid enrollees. The Carruth & Associates report notes, “[c]ost-[e]ffectiveness is only achieved, in the long-run, through a program that delivers high quality at the lowest cost possible to maintain the value.”2 A true measure of
a system’s cost-effectiveness does not simply examine the input (i.e. state funds being put into the Medicaid program), but also the output (i.e. the quality of care and health outcomes of enrollees being served).

Key findings of the Carruth & Associates report include:

    • When Medicaid caseloads grew by 93 percent between fiscal years (FY) 2002-2016, per member per month (PMPM) Medicaid costs increased only by a total of 17 percent, or just over one percent per year on average. This includes a significant cost increase in 2008, which was the direct result of provider rate increases due to the Frew v. Hawkins lawsuit.
    • Although Texas has been steadily expanding Medicaid managed care, it was not until FY 2013, when 80 percent of Medicaid enrollees were enrolled in managed care, that just over half of all Medicaid costs were finally under the capitated model. This was achieved after additional enrollees and geographic areas, prescription drug benefits, and nursing facility care were carved into managed care. Over the past almost 15 years, MCOs have been able to successfully bend the Medicaid cost curve while only controlling a portion of the Medicaid budget. Today, about 70 percent of the total Medicaid spend is within capitation.
    • Periods of significant growth in managed care tend to correspond with very low Medicaid PMPM cost growth, and in some cases, even declines:
      • From FYs 2012-2016, after the state underwent a large statewide managed care expansion, overall Medicaid caseloads increased by 11 percent, while total Medicaid costs increased by 17 percent.
      • However, Medicaid PMPM costs increased by less than one percent per year, while national health expenditures during this same time period experienced almost four percent per capita growth.
    • Two studies using similar methods, one conducted by HHSC in 2012, and one by Milliman in 2015, arrived at comparable outcomes in validating Medicaid managed care cost savings.
    • Both historical cost trend analysis and forecasted studies have demonstrated the cost-effectiveness of the Texas Medicaid managed care program.

Medicaid managed care has been demonstrated as one of the most effective means of bending the ever-increasing Medicaid cost curve and providing high-quality health care coverage. Health plans are able to provide better care by helping coordinate and “manage” an enrollee’s health care to more preventive, lower cost settings, and by utilizing the providers within their networks. Plans also assume financial risk should costs exceed the negotiated PMPM rate, which provides budget certainty for the state.

Since its inception as a small pilot program in the 1990’s, Medicaid managed care has grown into one of the state’s most successful initiatives, allowing Texas to utilize private sector businesses and free market innovation to better deliver government-sponsored programs. As lawmakers further explore the Medicaid managed care model in coming interim committee hearings and form recommendations for the 86th Legislative Session, it is imperative that state leaders continue to fully embrace this model and reject policies that would hinder an
MCO’s ability to continue providing higher-quality cost-effective care to the state’s Medicaid and CHIP populations.

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