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Managed Care Insights Episode 8

Show Summary

Episode 8 of Medicaid Managed Care Insights hot topics:

Dr. Wright joins us to talk about the CareSource Indiana re-entry program.

The big news in Medicaid managed care the past 30 days

Key regulatory changes that impact your business.

One of a kind analysis of Managed Care procurements

Vendors to watch

MCO financial news

Co-Host & Speaker

Richard Topping,

Chief Legal Officer

CareSource

Click here for Bio

As Chief Legal Officer, Richard Topping leads CareSource’s assurance and advocacy teams including legal, internal audit, compliance and risk, program integrity, policy, government relations, and corporate governance. He also serves as the lead executive for the organization’s veteran and military service programs.

Richard was recruited, along with the Mintz Law Firm, for his in-the-trenches experience in highly politicized, new health care delivery systems—like the entry of Medicaid managed care into a fee-for-service state, and the implementation of the MISSION Act to allow veterans better access to health care. His unique experience as an attorney and a health plan executive coupled with his Medicaid, VA and TRICARE expertise creates a unique perspective for the build out of new government healthcare programs.

Before coming to CareSource, he served as CEO of Shao, Inc., a technology partnership between health plans and telecom carriers that provided plans and their members with tools to align incentives, share data, and create actionable decision pathways to lower costs and improve health. Prior to Shao, Richard served as an appointee to North Carolina Governor Pat McCrory and as the CEO and General Counsel of Cardinal Innovations Healthcare. In those roles, he helped guide the state through its transition to capitated IDD and mental health services and subsequent full conversion to a managed Medicaid program.

Richard was an attorney at the U.S. Department of Justice for the George W. Bush Administration. There he represented the Secretary of Health and Human Services during the height of clinical disputes over the relationship between vaccines and autism in children. He also served as counsel at the Center for Bioethics at Brigham and Women’s Hospital and Harvard Medical School in Boston.

Richard began his career as a U.S. Army infantry officer, and then served as a JAG officer specializing in health care finance and hospitals. He has Bachelor of Arts from College of the Holy Cross, a Juris Doctor from the University of Connecticut and a Master of Public Health from Harvard University with a concentration in health law and policy.

Dr. Cameual Wright,

Medical Director, Indiana Market

CareSource

Click here for Bio

Video

Transcript

0:03Hello everyone. Thanks for joining us for episode 8 of Medicaid Managed Care in sites where we talk about all the MCO news and the last 30 days or so. We may do a little bit more than 30 days this time since this is our first one of the year of 2020 and as always our as for the last several episodes and hopefully many more.

0:24I've got my co-host rich or topping Richard for folks that haven't heard your your bio and intro before if you don't mind give them a Quick thumbnail of what you're up to these days. Well, thanks for having me again clay, we're topping. I'm the chief legal officer at Care Source and I'm on sort of on the health care practice at mints in the Washington DC office. Excellent. Thank you for being here and we're also going to have a special guest today. Dr. Cameual, right? She's going to talk about the Care Source Indiana re-entry program. So for folks that have been joining. I've been trying to in addition to the news of and trying to mix in sort of the guest segment to Showcase something.

1:02That I think is innovative that other mcos would think is cool. And this case it's Doctor Wright's work with re-entry program. I think the last episode we had Abner Mason with could say oh, so no talking about text messaging stuff. He does with vendors and we're actually taking nominations. If you want to send a note clay@mostlyMedicaid.com you might like to see in a future episode, but we'll hear from dr. Wright later our agenda. Today. We're going to do a quick bit of reg watch. We got a couple of new CMS.

1:32Sytems out will do MCO news this time. I've organized it largely by market based on some feedback to show you what's happening in Kentucky and Louisiana and North Carolina. So and other places we'll talk a little bit about sensing Wilco deal, then we'll hear from dr. Rai and then we'll do some RFP track in which this is a very very busy surprise. We turn around and all of a sudden there's tons of stuff happening in January and February so we'll get into some of those details as well.

2:02Forget to submit your questions and comments. You can type them in the webinar our newer approach it what we found to be more effective is will collect them all and we'll respond after the show one big group. That way everyone can benefit if you want to if you want to give us some comments that's great too will post them anonymously. We now have moved to sort of a show notes page. So not only will you be able to watch the recording. I think we're doing audio versions now for all you young whippersnappers love podcasts.

2:32I've gotten into him lately too and you'll be able to like look at the prep pack. So myself and Richard we always kind of have a lot of stuff. We look at ahead of time in terms of like news articles or outlines that kind of stuff and you'll see where questions and comments happen to and you'll get and you'll get a link to that in the newsletter. But so go ahead and submit your questions and comments today and will respond to them after this show. All right. So reg watch I mentioned there's to CMS items.

3:02We've got guys guidance on 340b around duplicate discounts in relation to the 2m D RP and 340b and then covers across state lines for kids will talk about that and we'll kind of just do a quick little thing on the North Carolina budget. Its I guess it's a reg since it's a law or build a budget bill first item CMS issues guidance to States on 340b duplicate discounts.

3:28So CMS is basically saying here's the best ideas we have On avoiding duplicate discount issues which which the way in the what they're getting at is so under the Medicaid drug rebate program manufacturer has to offer discount but also under the 340b program they have to offer discount. They're not snare the twine or supposed to meet but it does happen and CMS is trying to publish some some thoughts on how to prevent that there's this informational bulletin they put out and I think the reason I'm bringing up here.

4:02Here is from what I've been reading. I think mcos may be on the hook for new compliance efforts around this to the extent that they're they're managing some of this Richard thoughts. I mean, that's the setup. What's your kind of hot take on this one? Yeah. I mean I get it. This is going to be you know, just one more added layer of complexity, you know, and as everybody knows the way to make something less expensive is to make it more complicated said no one ever the the I think the challenge here is you know drugs.

4:32Icing is you know, I mean, it is a major Challenge and that's a big part, you know, the PBM issues that are front and center and you know in many states and this is just sort of one more layer. And so the I'm not sure we're really going to get back to where we're trying to be by you know, adding more requirements. You know, I'd like to see if there's a way to peel some of these back so we can actually get down to pricing and some competition but but I understand why we're doing this but this to me is a Band-Aid that's going to make it more difficult and therefore more expensive.

5:03Right. Well, I mean there's no doubt. I mean any time there's well, I would say make it more complicated as the number one way to make a more expensive but also right thank you regulate it more which I guess is this is another way of saying make more complicated. Maybe maybe just maybe you might disagree, but maybe it's going to maybe it's going to suck a little more in the near term but it will start to get better. I mean, I would imagine the manufacturers once some sort of solution on this so that pain pills for you there.

5:33Okay, thank you for your comments on that. Let's move on to the next one. So this one is interesting because I've done a little bit of work in this specific area about children across state lines, you know, you may need a provider that doesn't really operate in your state but it's right across the state line. There's various scenarios, but CMS is seeking guidance on Medicaid coverage for children provided across state lines. So I think this is another one.

6:02Our CMS is sort of recognizing the complexity and there I guess maybe they put out an RFI or something asking for you know, what are the Barrett? What are the what makes it hard right as well as what are the best practices about coordinating care across state law for our state providers in emergency and Non-Emergency setting what are the financial regulatory administrative barriers both for the kiddos and the providers to try to get these things delivered across state lines.

6:32You know, are there any new are there any enhancements to provide enrollment processes for out-of-state providers? That might help but it's so first I guess for anyone in on the call that has some thoughts on this weigh-in. I think CMS is taking comments on this until March 20th of this year of 2020 Richard any thinking any thoughts on this one? No, I'm excited to see response. Isn't it?6:58You know, everybody wants to get this right it's difficult to do but everybody wants to take care of kids and this is you know, this is the potential to get coordination between both payers providers the pain Point. Everyone's trying to get to the same place. So excited to see what comes out of this. I think this is a good opportunity for all, you know all around right nice and I do think this will hit MC has been the the one of the things that I have been involved in. This was actually a provider a like children's special respiratory services provider trying to get enrolled in an MCO across the state line.

7:32Yeah, yeah, so hopefully we'll have some some progress on this. Let's move on we won't talk about this with that much that people up north are North Carolina don't scream have a budget and it's the way this is for folks who have been watching the wonderful North Carolina Drama unfold right before our very eyes with many twists and turns and subplots. And another thing character development. This article is about going to op-ed.

8:02He's like no No, everybody's been saying we don't have a budget. He's like actually do have a budget technically because whenever we don't pass a new budget, it's really just last year's budget with whatever many budget right. So, I mean that's really the upshot of this one.

8:14But you know, all the Managed Care implementation money is rolled up in this, you know, all kinds of other things expansion Richard any other things we haven't covered like in the last episode or you know, I mean don't weigh in on this critical component on this is they've got a Budget but it's the last budget and it does not include Medicaid transformation. And so North Carolina is not going to have Medicaid Managed Care certainly before the 2020 elections and depending on how those go may not have it in 2021 either and so right so North North Carolina continues to be in the Dark Ages when it comes to Medicaid Health Care, right and that's basically what I thought and I think the latest slip date is February, but that's just because that's the lightest one that's been put out.

9:01Nobody is thinking that's what's actually right. No, there was an attempt. I think the legislature there are met in January with an attempt to get an override. But but even now you've got the legislature on one side of this to the administration on the other and it's certainly not going to resolve it before they reconvene for the session this year and so right so this is definitely off until you know after the election right? Thank you. Stay tuned on North Carolina.

9:29I will move into More MCO news, excuse me. I will do have cough today. We'll talk about something WellCare update. I think Richard Yuna and the green room we're talking about the deals actually done now, so we'll talk a little bit about that.

9:43And then I'm going to do the other news by market probably skip through a lot of the North Carolina stuff pretty quickly, but we've got you know, this this this month the the story is really protests by market and multiple talk about that a couple other little a criminais type things sentain well, I care this was merger nears the Finish Line. I think it is at the Finish Line. I think it's done now based on everything we've seen, you know, it makes them and correct me if I'm wrong. But it you know, it's going to make them the largest Medicaid managed care plan, right? I think well, I mean largest government programs Planet, I mean overall 22 million 22 million members top line revenue of about a hundred billion, and I think I saw one number.

10:31That's correct. But but it sounds correct one and 15 Americans will be enrolled with 17, which is really wow, Mark. Wow. Wow to be their Medicare Marketplace and Medicaid plans. So it's really the scope of this. I think the significance, you know for everybody across the industry is it's not that you've got a large insurer. Obviously. There are there are many large insurers out there including large events and teen but this is the first truly fully government program.

11:01Alms pair to be of this size and scope. So this is going to have Downstream Market effects that you know, we're all gonna have to see how this plays out. But this is this is a big deal right ride it the numbers. I'm looking at in this article, which is before it closed was 17 billion is the total merger, I guess 22 the deal. Yeah. Yeah. Yeah and then twelve point eight million just on the Medicaid side.

11:31Also, you might know more about this than I do, but I've been reading like if you look at like, you know, they always have to divest different plans and different markets to appease J or whatever and and the way some of those have gone. I think people are starting to say, okay. Well, it looks like maybe the old well care brand is going to be like Medicare Advantage Focus or whatever. Have you does that make sense? Have you seen that too or is that enough? You know, I think I've heard the gossip about that same way, too.

12:01To not entirely sure, you know, I think the the regardless of how they branded. I mean the bottom line is of both of these organizations are incredibly capable in the space.

12:12And if and if you know government programs is the fastest-growing part of healthcare and and Medicaid is the fastest growing part of that and this is now, you know, arguably the two largest most capable companies in that space together regardless of how they branded the capabilities are there, you know, Under One Roof and so they put this together, you know, they'll be a little bit of Lag is a as they're fully Consolidated and figure it out. But you know, this is this is you know significant right on that note. I think based on some work we've done in the last two years. I think the integrated plans Medicare Medicare integrated like Snips the hottest and I think that's where a lot of the options going to be in the next year or so. All right. Let's move on to the debate over Medicaid expansion, North Carolina. I think we really covered that with your comments earlier.

13:01Yeah, that's that's what administration's view is. You know, they'll Implement managed care and return for expansion rights later view is you know, we're not going to do expansion. So that's you know, that's going regardless of the budget that's going to drive that it passed through the three election right? Well, maybe I don't think about a chance to tell you but I think I've decided that waiting list or the hill. I'm going to die on this year.

13:26Maybe I'll be able to give enough you laugh because you understand the what I Where I'm going with that I'm saying hey there do all you folks at think expansion is just wonderful and you're climbing the moral High Ground blah blah blah tell you what clear the flipping waiting list first, and then I'll listen to yep. So yeah. Anyway, maybe I'll get enough content out there ahead of this that it might maybe I can swing since thinking they're in North Carolina.

13:50I'll say and of course, there's still, you know, the various constipated protest stuff in over the awards for the Managed care business that doesn't exist and yeah Carolina, I don't think there's any yeah, right. Hey, let's talk. I mean think about the money that's being spent on these Awards on the plans on the state side or whatever just on this litigious process for a market that doesn't exist in may not for some time. Well, it's true. Yeah, you're right. You might get a judge to throw out the awards that don't exist for the market. That isn't real.

14:30That's definitely an Development I thought I would say that's a legitimate ruling. Yep. That could come back when we've got a Managed Care environment in the state law go fight about something else. Let's look at Kentucky. So there's a couple interesting ones Kentucky and Louisiana both. Yeah there but basically, you know, Kentucky throughout their recent.

14:58Excuse me, Awards, you know, Now this is interesting for a lot of different reasons not the least of which you've got Bashir to the new governor has Daddy used to be going to but he came in I you know My Views he's just trying to undo everything Bevin and he's like, you know what those Awards child's did we're going to redo those now in his defense. I think the like legislative committee that was involved. They also said we don't want you know, we disagree with these Awards, you know separate from all that but now it's being real it will give ya will be rebuilt.

15:31We will give some more details on that. We got the RFP schedule, you know, the most interesting thing to me is I think this gives passport the chance to live another day, which they didn't in the past one and the previous ones which I would think just politically as far as the Homegrown plan, you know being mixed in the last one that kind of stuff. I would think that matters a lot and what we're seeing now, but what are your thoughts on this one who does I mean specifically the past?

16:01Sport this does give passport a chance for award and the comments by the new governor his team about, you know about the way the Bevin Administration handled the awards including talking about you know, better that there are of course the passport the certainly gives them a chance to be back in but I think collectively as we talk through these in our theme for today is is the procurement process and every state has been, you know been on the been on the brink.

16:31For a while and I think right Wayne between little bit North Carolina. Certainly Kentucky Louisiana, you're starting to look that the procurement process as it has been has largely not been functional and these are these are giant contracts huge implications for lots of folks political Financial policy implications.

16:52I think what we are starting to see is the end of the, you know, the historical procurement process as it was don't know where it's going to go, but you Can see that this is proving not to be whether it be, you know, DC's constant re bids or now, Kentucky and Louisiana. This is going to change and how it changes. You know, we're all going to see absolutely and I think it's been brewing.

17:16It's been it's come to a head for probably two or three years, but I see even in some of the you know states are asking for help planning managed care rfps more and more and some of the art like Consulting our fees or whatever and I see them Kind of acknowledging. Hey, we've got to find a different way to do this. Yeah, let's do Hawaii. Basically from what I've gathered, you know, Hawaii, I think they reduce the number of mcos down to four. Maybe is that right? I think there's a little bit of friction there, but I haven't seen anything yet as far as a protest.17:56So I think that that's just kind of the update is hey, it was awarded and you No, some people are not happy that there's less there's less chairs in the musical chairs game. I think you get it like the more you dive into it. There's some things about folks some Partnerships. They thought would end up being Statewide that were not but if anybody has any additional questions on that either look for the prep pack 1/3 out with show notes or feel free to to to send me a note, Louisiana.18:29So another Awarded and thrown out. The latest I've seen is the I guess there's like a state procurement officer and she said y'all did not do this, right? It's fatally plot flatty fatally flawed. You didn't follow your own evaluation procedures and you change the way you looked at them kind of Midstream. It's pretty big deal right now mcos contracts account for a quarter of Louisiana's annual operating.19:01Budget there's a lot of a lot of news on this out there. I guess my question is really what's the next step because even the agency this is unlike Kentucky. This is one in which you know, you've got the governor in the agency saying no, we're cool with these even the agency is filed in the protesting the procurement officers decision. I'm not exactly sure where it goes next. But I think this is another if I remember right when the words came out.19:30I think this is the one where we Like a sitting us Congressman might make a comment saying well, maybe you should have awarded this other plan. I think I think that's what that was. Like in the fall. Where do you think this one's going to go Richard? I don't know Vector comment has been brewing for a while this to me seems to be the Tipping Point.19:47It's a fully expanded mature Market has done this before and this and this goes to show that and I understand there's questions about specific details and what happened when and where but this this strikes me as as as sort of the Pinnacle of the fact that this is a process failure not individual and so it's going to be it's going to be interesting to see how this shakes out.20:11But you know, I think we Zanna because it's a little bit further ahead and its procurement process what the path forward we're going to see some of that with Hannah burst because this so let me ask you to see Ryan and I think with right Louisiana also was one of the very few Southern States Expanded. So I think there's a lot of there's also a lot of focus like if you read the op-eds and that market which I read them and every Market there's a clear. Hey, we told you so you spent way more than you should have that kind of stuff. So I think that's involved here too. I think dr. Guy is stepping down. She may have already stepped down but she's been there for quite a while. Yeah.20:53There's a lot on this we've got I mean, I'm looking at like five stories we put together and prep for this so look for if you're interested in Louisiana different look for the prep pack moving on to Pennsylvania. This is just a quick possible acquisition. Help parts are Partners plans there by that would just kind of starting to track a little bit. I don't know if there's been any movement on this since we think this is yeah, this is mid-January when we when we saw that have you tracked anything on this one Richard about know.21:31Go ahead now and put another state that can't do procurement. So right so right. So even if I like this morning show, right even if Thomas Jefferson is successful in buying Health Partners plans. They will win a seat in the cluster that is Medicaid procure. All right. Congratulations. What have you this again? Quick here that Total Healthcare and Priority Health murderers.22:01Has reached all the approvals that it needs to we've talked about this a few other times the intro to me the interesting part of this deal was always the 25 million dollar check that was cut to a local Foundation. I think in Detroit. Did you want to weigh in on this one at all? Richard Ford? No, I didn't I didn't follow it whether that was a conversion or not. But and you may know Clay I you know, I didn't but yeah, that's the 25 million bucks, right?22:31Say Molina looks I think they're buying some footprint in Illinois with one who thereby now, let's see. What of the with Next Level. Yes. Yes, you're right. It is next level and therefore moles of a small Chicago area network any specific plan.22:49So that's its interested what I mean what that does show is Molina's commitment to continue to grow, you know, lots of folks sometimes count Molina down, but you know, they're not out and so This acquisition give them a chance and Aetna is now and the Illinois Market as well too. And when I care is a dissenting divestiture. So you got you know, you know to to plans and during that market via Acquisitions and so you know, Illinois is you know, you know as is no secret has been a difficult Market not even Revenue wise but just with the state's timeliness of payments and so be interesting to see how this one goes as well. Yeah.23:31Yeah, I have now for five years of fraud to Illinois Managed Care is the dumpster fire of the medical. It has been I mean I have so many stories of of plans telling me. Hey, yeah be great if we could just get you know paid for the last year and a half cap payments, right? I'll attend to more buying their way into that saying, you know how we think we think it'll work this time. So that's right.24:01Both Molina and at you mentioned some people would have counted out Molina. I would have counted out it two years ago looking at you know, yeah, whatever. They've been kind of on the warpath. I had some wins, you know, this particular one Molina's buying I think it's the deals around 50 million bucks for like 50,000 MLT SS members, I thank but yeah, I don't love 40 something about 45. Yeah, you're right. But yeah, we'll see.24:30Where they take this will see what it says for the Illinois Market. I'm going to we're about to enter I think into the a couple of RFP profiles just a reminder. Don't forget to submit your questions and comments and I think it helps everybody when we when we get those and I can respond back and everybody can benefit from those next up. We're very fortunate and happy to have with us. Dr. Campbell right from Care Source and she's going to talk to us about the Indiana re-entry program. So I'm going to hand it over to you. Dr. Wright.25:01I will advance the slots.25:04Thank you so much clay and thank you for the opportunity to come and share a little bit of our findings with the group. So today I'm going to talk about our re-entry program and I believe that this is potentially a model for for dealing with social determinants in the community as well as interfacing with state agencies.25:33Next slide please. Re-entry program actually was born out of a recognized need we are new to the Medicaid Market in Indiana and we launched our Medicaid plan and 2017. And one of the things that we realized very quickly. Was that a large portion of our membership where individuals who are returning to society.26:02after incarceration these members obviously have tremendous challenges including physical issues behavioral health concerns and then a myriad of social concerns that come with reintegrate into society finding sustainable housing and income and dealing with relationships and basic needs we Quickly discovered that there was a need to put together a program and be very intentional and serving this population and helping to deal with both those physical needs as well as the social needs. So we worked with the Department of Correction and the family and Social Services Administration and we are now in a position.27:02Pilot program with the Department of Corrections. We are in year 3 of the pilot program which involves both in reach engagement of offenders while they're incarcerated as well as care coordination and support after incarceration. So there are three main components to our program one is that we have a dedicated reentry.27:32Team, there are four individuals on our team and these individuals focus on both the education that we provide in the facilities as well as post-incarceration care coordination. So a member or members of our team are present at all, 15 state-run facilities in Indiana, and they initially engage with a thing.28:02Thunders during their pre-release curriculum. Our team goes in and educate them on Medicaid why they want and health insurance what the benefits are of health insurance and then most importantly how to connect with us after incarceration after they are released.28:24We obtain information from the state and those individuals who are released and either we Outreach to Down or they Outreach to us.28:35So we get several calls a day from returning citizens who saw our presentation and want to engage with us and then the team make sure that their Medicaid benefits are active determines what their physical and behavioral health needs are and get them into the appropriate providers and also works to link them with Community agencies to to be able to help address those needs. So this just goes over again those those operations initially and pre-release we engage with them post-release.29:14We really are the glue that links them to not only their medical services but also Community Resources, so we help them to to really get to the point where they're stabilized and hopefully Next slide please.29:37We also offer expungement. So one of the things that we have recognized is that having a criminal record is a significant hindrance to many things like jobs Education certification Etc. So we will pay up to 500 dollars for the cost of expungement provided the members meet certain criteria.30:02Looks like One of them are important components and characters is another department called live services and this department is dedicated to dealing with those social determinants of Health next slide. So there are three. We have an aspect of life Services call Job connect and there are three components of our job to make team won our enrollment Specialists.30:31They Outreach to members including Our Justice involve members to explain the program should and member decide to engage with our program. They will be assigned a life coach that life coach will work with them for up to two years and help them to obtain employment or educational goals and also to address any social determinants of Health that might be a hindrance to those goals. Finally our employment Relations Specialist work with employers.31:03To to make connections to allow our members to gain employment. So we have over a hundred eighty employer Partners who are willing to work with our members to hire our members and the majority of those employer Partners our Second Chance employers which are willing to hire those with a criminal background.31:32Lastly I'm going to talk about quality. We do measure several analytics to make sure that we are moving the needle and our that our efforts are successful. And here's the early trends that we've seen the state has a health risk assessment. It's very difficult to obtain.31:55We have noticed that about 40% that are returning citizens about 40% More likely to complete that Health needs screening. There are 20 percent more likely to obtain a behavioral health visit compared to our general population. There are sixteen percent more likely to be identified as medically frail. That's a category of Medicaid services that allow certain members with with physical or behavioral health conditions to have a higher level of services. They're 20% more likely to have a preventative visit.32:31Which is really important therefore percent less likely to go to the Ed and there are 30% more likely to receive appropriate follow-up after a behavioral health hospitalization. So we're really noticing that that were moving the needle on the health of these individuals and their quality of life. We're excited to have this program and we look forward to continued wins in this space.33:02Thank you very much doctor, right and for folks that would like to contact. Dr. Wright. Her email is up on the up on the screen if you're watching this lots and not just listening. So thank you very much for joining very important program. I know all the folks that I know that work in Managed Care would be excited about doing something like this if they're not already doing it. So thank you for joining us today. Thank you.33:25I appreciate the opportunity RFP track gain, so I'm going to do I think a DC and a couple other quick little hits just profiles of these to show you some ones that are up and then we'll do then we'll do the schedule. And then what I think we're done after that, but so the DC one, this is interesting. I think Richard you mentioned earlier about how they're sort of in continuous procurement, but it's interesting how it happened. So in April, 20 19, they are awarded the contracts and then you know, I guess five months later like, oh we're going to rebuild them in this time.34:00We're going to put in From population or more populations the total lives. Here's like 200,000. They're going to add 20 mm. They're going to go down to 3 m cos like I say a for now looking at the incumbent list RFP came out a couple weeks ago. It's due January 31 and the goal. I will be October 20 20, you know the big the big incumbent. There's more Healthcare toss followed by Anthem if you're looking at the slides, I don't know if you're listening or looking at the video.34:31Go but if you look at the video, you can see the market share their Amir Amir help Caritas at 60% anthem at 22% trusted helpful and they're at 16% and then a health services for children with special needs 3% Any big ground-shaking predictions on this one Richard?34:49No, just I think what's notable about this other than third time's a charm is that they're now saying if you're going to be in the market you've got to be able to do a video and so this is consistent with writing, you know the larger Stations around if you're going to be in government programs going to do Medicaid, you've got to be able to focus on high Acuity that that is no longer optional capability. It's about serving the entire population. Not not just an internship. Right, right. Yeah, good good point and I mean, I personally welcome that I mean, I think that's where we need the most help but I think the private sector can breathe. I think I've got the yeah, so I've been putting up the scoring stuff just to where you know, every state kind of looks at it differently.35:31Lee this will be you know, if you're if you're watching the video I'm not going to read all these out but you can hit pause and look at how the different point scoring systems that each of the states are using this is the one for the for the DC moving on to Kentucky. We talked about a little bit. So in November those Awards have now been cleared out were announced at the legislative committee rejected them. They didn't like the governor Bevins team went ahead with them and December 2019.36:01New governor beshear cancel them and also pulled the work requirements in a related waiver component 5m cos will get a chance and I think we talked about passport RFP was let out in January 10. I'm showing like an inch. I'll have to go back and figure what's going on, but I think the proposals are due the seventh but we're doing a go live until January 2021. So the proposals are due February 7th, but the go-live not till January 2020.36:31One so I guess everybody that's in now rides for another year. There wasn't a push to do like a six-month anything in there. You can see the incumbents up on the screen, you know and descending order well care passed forward and Humana Anthem any any comments. We haven't covered on this yet Richard any thoughts on the letting it roll for another year piece of those other than just recognizing that this is although it's technically a rebid of the of the past procurement.37:01You know, it's reflective of the new Governor's priorities policy priorities going in with right. You bet your check them out on the work requirements face. Is that right? Correct? Right, right. So here's the scoring on the Kentucky RFP piece quick side note on the work requirements. We talked about this in the other show this month the news show this month. I think it's Nebraska that is moving forward with similar to an Indiana.37:31Model in which work requirements don't exclude you from coverage, but they do allow you to get better coverage. So if you meet certain conditions, then you're in like a different tiered place or whatever and I've been pointing to that as a way forward for work requirements as a policy and I think we'll see especially if we end up with Nebraska on there to kind of adopting the Indiana model. But anyway, that's that's a different topic will cover the if you're interested in that make sure you check out the February news Roundtable. We'll get into that in more.38:01Detail West Virginia. This is another one December. The RFP is let they're going to Warp 3 mcos four hundred eight thousand lives. So almost twice as much. So on and DC proposals are due February 12th. Go live July of this year. You can see the incumbents here.38:19This is a anthem at the market and then the health plan upper, Ohio Valley any thoughts on West, Virginia Nope, tough Market tough Market. Yeah. Yeah. What what do you think makes it tough? Like the geography the what's the heart? I don't I know next to nothing about West Virginia sighs. Yeah Sighs and providers. And again you've got incumbents are too I mean, I think that said be a difficult market for somebody else to break into but we'll see you in there is some m&a activity to but strong provider networks, and I think just at the demographics overall.38:55So if you and I ever start a health plan, we should take West Virginia as a challenge is where your say that would have we would put that on the challenge list. And now I want to come up with Health Plan names, but we'll do that at some other time. Here's the scoring here thousand points possible with a third of it on the cost side for for West Virginia for folks interested in bidding against mr.39:22Topping sound advice and west So I think that yeah, I think that's it for today. The next show will be March again taking nominations for the next guest topic for anybody that that you like for us to hear from you think others like hear from if you need help with any of this stuff the business of Medicaid Managed Care semi no clay IT muscle McCain.com, and I think I've got a ceu code in here somewhere for for you all. Thanks again Richard for doing this.39:54We think happening and thank you. Dr. Wright. Yeah. Thanks for being here both I and here's the CPU code folks. See think I spelled that right if you're here for the see you send a note to me clap most Medicaid.com, and we'll send you a certificate for one unit of see you Richard any parting comments anything you didn't get to say you wish you did before we close not at all. And if not, I'll say it again later. Thanks a lot, man. Appreciate you being here, and we'll talk to everybody soon. Bye.

MCI Series Episode 8 Show Notes

Managed Care Insights Episode 8

Show Summary

Episode 8 of Medicaid Managed Care Insights hot topics:

The big news in Medicaid managed care the past 30 days

Key regulatory changes that impact your business.

One of a kind analysis of Managed Care procurements

Vendors to watch

MCO financial news

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