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Becker’s Healthcare Podcast
Navigating Medicaid Redeterminations and Market Shifts with CalOptima Health Leadership with Michael Hunn & Yunkyung Kim
00:21:55
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- [00:02]
A
This is where health insurance leadership comes together. Becker's 4th Annual Spring Payer Issues Roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you here in Chicago. Hello everyone, this is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by Michael Hun who serves as the CEO of CalOptima Health, and Y.K. kim, who serves as CEO at CalOptima. Michael W.K. thank you so much for taking the time to be with me on the podcast today.
- [00:52]
B
Great, thanks Jacob.
- [00:54]
A
So Michael, why don't you get us started by filling in the audience on anyone who might not be familiar. Can you tell us a little bit about your healthcare career background and then give us an overview of your current role at Caloptima?
- [01:07]
B
So I started my career in acute care hospitals. I actually became a CEO at age 36. So I've been sitting in the chair a lot of years. I've run psychiatric hospitals, I've run long term acute care hospitals, I have run community hospitals, I have run tertiary hospitals. I've not had the privilege of running an academic medical center, but have had the privilege of working in as CEO. 12 different hospitals in my career, six different corporations or systems, and most recently I ran the Providence Health System out here in Southern California. So I've had a very interesting career on the acute care side, including medical groups, long term care, long term acute care, as well as skilled nursing, as well as psychiatric, pediatric, adult and geriatric, and am now on the Medicaid acute health plan side for almost 10 years now.
- [02:09]
A
Wonderful. Thanks Michael. And how about you YK Jacob?
- [02:13]
C
It's a pleasure to join you today. Yoon Gyeong Kim, also go by YK. I'm the Chief Operating Officer of CalOptima Health. I've spent about 25 years mostly in the public payer space. My area of interest has always been in the Medicaid program and then the programs that serve the families and communities around Medicaid, including Medicare, Duals and the ACA programs. I've had the pleasure of being able to see Medicaid Medical in California from the lens of public plans like Caloptima Health as well as from the publicly traded plan space and the nonprofit space. I've worked in Medi Cal up and down California in multiple counties and have seen again the differences in how each of the local markets function based on size, based on the number of health plans, based on the availability and the partnerships with health systems. I've been here at calophma Health now for a little over four years in this role and have the pleasure of leading our core operations coupled with our provider network, our provider systems and partnerships closely aligned with our technology, our IT team, our quality. We've really closely aligned quality with our provider partnerships as well as with technology and then also with our business programs. Right now that's Medi Cal again, Medicaid for California Medicare. We have a dual eligible special needs plan, one Care and our PACE program, program of all inclusive care for the elderly.
- [04:00]
A
Wonderful. Well yk, given your expertise on this topic, I want to get started by talking to you first about everything coming down the pipeline with HR1. As I'm sure you can imagine, this has been a major topic leaders in this industry all over the country for the last almost year now since the or. Yeah, just about a year this summer since the legislation was passed. And I know Caloptima has really been doing a lot of work to prepare for this. The company has committed nearly $20 million to help members navigate some of these eligibility changes stemming from from the legislation. And you know, we've got work requirements coming down the pipe, semi annual eligibility redeterminations starting next year. So how is your organization operationally preparing to prevent large scale coverage losses looking into the next few years?
- [04:54]
C
That's a great question. You know, the changes under HR1, as you stated, are really around potential coverage losses. They are likely going to impact the number of individuals and families who remain eligible for Medi Cal in California. The thing that we've been really preparing for, as you alluded to, is making sure that our communities stay informed on the changes. There are a lot of different eligibility policies that go into play at different times. Coupled with HR1 for California, we also have changes, policy changes that are stemming from state budget policy decisions as well. So the first thing that we've been doing is really stressing the importance of factual, timely information for all of our communities that includes not only our eligible members, but also our providers. So that as a community we are clear on what impacts we can expect to see and then how we can collectively get ahead of them. So to that effect, we have committed nearly $20 million to outreach, navigation, education, information campaign to make sure that no one is Losing coverage because they don't understand the changes or because they don't have the information to act on those changes. That's really the first thing that we've done. And that's also included educating our own internal teams so that we can provide consistent, factual information to everybody who's calling us, whether they're calling in through the customer service line or if it's a provider calling in to ask about contract or claims changes. So that's the first thing that we're doing. I think the second thing that we're doing is really trying to partner with our providers to make sure that they are well positioned with information to help them plan their, not only their budgets, but also their operations. So as we get information, as we do our projections, we are sharing those with our providers. I think we've said this often. Michael said this often, we are nothing without our providers. And so as we do the planning, the important thing really is at the point of service, how prepared are our providers to not only help their patients navigate, but also to help their offices operationalize the changes and deal with potential patient losses, most likely patient losses. So helping with those types of support activities, we also continue to promote as much access to health care right now as possible. And that also includes partnering with our providers about how they can expand access. That's not just a patient access issue, but it's also some office and business planning for provider offices. How can they continue to see patients? How can they continue to be reimbursed for seeing patients? So we are continuing to again, promote access to health care, regular access to health care, for as long as everyone who is eligible remains covered under those services.
- [08:11]
A
Understood. A lot of different policy change, intricate policy changes going into effect across a lot of different timelines. A lot of communication that has to happen with your provider network and your members. Michael, anything you would add here and going off of what YK mentioned in terms of patient losses for your provider network, can you share any projections in terms of how many of your members could lose coverage over these next few years as a result of this?
- [08:36]
B
So I think clearly, if I'm sitting in a hospital CEO chair and I'm running an emergency department as the enrollment drops because there are new requirements and impediments to receiving care, that's going to turn into uncompensated care or charity care, and with the restriction that we can't spend federal dollars on undocumented individuals. So that's going to be a complicator. And if I'm looking at that I want to make sure I'm in front of the enrollment numbers as they come down. So what we do is I host a hospital CEO consortium meeting at our offices every quarter, and I invite all the CEOs from the hospitals in our community. We have 44 hospitals in Orange County. That includes our specialty hospital and our academic medical center. We don't have any public hospitals. So when a member loses enrollment, whether they're undocumented or if they're a US Citizen and they let their enrollment lapse, they're going to end up potentially in the emergency room with a critical issue, and that's going to be uncompensated care. So we're trying to educate our hospital CEOs around how many individuals are up for re enrollment in a given month. We are talking about what we're looking at in terms of discharge planning. We are starting to try to coordinate with our community clinics and any free clinics in the community, particularly around the early issues with prescriptions. So individuals who stop taking blood pressure medicine, individuals that stop taking insulin for diabetes and other disease states, that's going to be the first hit are individuals that lose coverage and then can't afford their medication, rent and food. So they're going to have to give up something and they're going to keep a house, hopefully over their head, but they may give up those prescriptions. So that's a real concern right now. So we are in active conversation with our hospital CEOs and community hospitals to say, okay, what can we do to figure out, all right, if we don't have access to Medi Cal or Medicaid, then what? How are we going to work in the community? Where are there other resources? And we're advising them that if we keep this collaborative going, keep the dialogue, let's coordinate with their discharge planners on where they can find those resources in the community. So those are a couple of more things that I think, particularly for those that listen to the Beckers podcast, I encourage you. If you haven't sat down with your your local plan or your Medicaid plan, you need to. If you haven't sat with the social services folks at the county that may do the enrollments for your state, then you need to sit down with those folks. And with our communications plan, as YK pointed out, we want to make sure that the frequently asked questions are all answered the same way. So we have coordinated our FAQs with not only our call center for the health plan, but also with the county, with the hospitals, with the community clinics, with the federally qualified health clinics and with our other community navigators. So that no matter when the question gets asked by a Medi Cal or a Medicaid member, they get the same answer on what to do, how to do and maybe where to go.
- [12:06]
A
Absolutely. And Michael, I appreciate the call out there and the reminder for our hospital audience listening in about the the real risk of uncompensated care, the rise in uncompensated care on the horizon and planning around that. I remember when you when you joined us last year here on the podcast a piece of this conversation, you were telling us about CalOptima's plan to begin offering health benefits on the ACA Marketplace Uncovered California. That's the exchange there for our audience and that's for the 2027 plan year. The goal to serve the roughly 15,000 members who churn in and out of Medi Cal eligibility. But of course, since then, as you know, enhanced premium tax credits have expired. Marketplace enrollment is down a lot nationally, about a million people as of the current data and premiums have have jumped all over for subsidized enrollment enrollees. It's very expensive to purchase care on the marketplaces. So given all of that, any updates you can share with us on on the company's Plan 2027 marketplace launch?
- [13:12]
B
So YK has been leading the effort for us at the health plan. We are still looking to move forward. So I'm going to let YK kind of comment on exactly where we are as we look to approach the exchange and go on covered California here in the state. Y.K.
- [13:32]
C
thank you, Michael. Jacob, you're right. You're thinking the exact same thing that we've been thinking of in terms of our Marketplace launch for 2027 and how the environment has really shifted since we initially started this plan. We are still working towards a 2027 launch. We are right now in the depths of applications and licenses and working with our providers on contracts. But all of that work has maintained the speed and pace that we wanted to for a 2027 launch. You're right, the environment has really changed. It's becoming a costlier purchase in a market than it was a year ago when we were doing this. But I think that still speaks to the reason why Kalapima Health embarked on this. We want it to be a local, affordable option for our members and their families when their life circumstances change. And life circumstances are certainly changing right now. We think that we can still be, especially in this current evolving market, we can continue to provide a low cost option, an option for our families that still provides continuity with their providers, a familiar health plan who has known their health care and known their family's health care. So in a way, while costs may be rising, I think that speaks to an even more critical reason as to why a public plan like Caloptima Health would consider entering the market at this time. We've been keeping a close eye on enrollment for Orange County. We have seen that enrollment has not significantly dropped as of yet. Of course, we're keeping close eyes on that. But regardless of, I think the number of members that we may attract for those who need a local health plan, we want to be there for them, whether it's the 15,000 that we had expected at the beginning or smaller number than that.
- [15:43]
A
Sounds like a very fluid situation in terms of some of the data, but good to hear that Caloptima will be there as an option for families next year if that is something that they do pursue coverage wise. Let's switch gears here. And Michael, I want to talk about your retirement, which you announced just a little bit ago for effective for the end of this year, 2026. Congratulations, by the way. But you know, it's been quite an interesting period where you've been at the helm of Caloptima. As you know, you started there as interim CEO back in 2021. You've led the company through a lot of big periods for the, for the health insurance industry in general. There's the Medicaid unwinding period. Post Covid, you launched street medicine programs. You stood up a Calaim department to meet some of the new state requirements with California, invested $50 million in workforce development, set this, this marketplace launch in motion. So given all of that, what are you most proud of accomplishing during your time at the company?
- [16:46]
B
So I made a commitment to be here five years, and I'll be here five years as of November of this year. And so I told the board that I think in fairness to the next CEO, they should start in January to assume the budget for next year. And in this last four years and the fifth year to finish out at the end of this year, I think what I'm most proud of is the fact that we have built trust with our members and in the community. When we first started to host community events, we wouldn't have a lot of folks show up. And over this four years now, just as an example, this past year's back to school event, we had almost 4,000 people. And again, between kids and parents, it's impressive to see the individuals Come I look at the some 330 community events that we participated in last year here in Orange County, California. And without fail, the magnitude of our members coming and looking for assistance, help, advice, advice, guidance, navigation has really been heartening. They come to the events and of course, we're coordinating with our clinic and community partners. So whether it's food resources, whether it's immunization resources, dental and eye care, our community partners show up. And I think we've built an incredible collaborative with our community partners and also our schools and our school districts, as well as our city governments. And certainly we've kept our state and federal legislators well informed, and we have a lot of participation from them at our community events. So what I'm proud of is the trust that's been built between us and the members, us and our community partners, us and the districts, the school districts, and the elected officials. And most importantly, when I look at it from the providers, our hospitals, our doctors, our clinics, we're all in this together. And I think we come together routinely now to solve problems and figure out what can we do together to be successful. That's what I'm most proud of.
- [19:02]
A
Wonderful. Well, congratulations again, Michael. It's been great getting to hear about all the things that Caloptima has done over these last few years here from our perspective. But before we go today, is there anything else you'd like to share with the audience? Any final bits of advice while you have the ears of a lot of other leaders from across the country?
- [19:22]
B
So again, for all the different CEOs and executives and aspiring executives that listen to these podcasts about how to lead in times of change, I have standard sayings that I use with the team. YK knows them well. First, I'm not here to admire the problems. Let's make sure that we're dealing with the issues head on. Second, don't confuse activity for accomplishment. We can be running around thinking we're accomplishing something, but if you can't put a number up on the board and you can't show that you actually did something, in our case for the member, it's not that I called them five times to get a doctor appointment. It's I called them, I got the doctor appointment and they went to the doctor check mark. Now I have an accomplishment. And finally, always do your work with a purpose of mission. You have to love what you do, you have to be engaged in what you do, and you have to show up with a spirit of kindness. And I think when we do all those things in leadership, our members benefit, our organizations benefit, our communities benefit. And we as professionals and individuals benefit because we end up ultimately doing the right thing.
- [20:37]
A
And yk, how about you? Any other final thoughts or final bits of advice you'd share with the audience?
- [20:42]
C
Thank you. You know, I think one of the things that really Michael alluded to for Orange county has been our building trust with our local community and us sharing information, reaching out to each other, not looking to just protect ourselves. And I think that's really what's going to help us get through the next few years of all of these changes, policy changes, budget changes. We don't do health care alone. The payers and the providers. I think it's easy for us to try to go into retraction mode, protect ourselves. We won't get through this if we do that. I think it's a real important time for us to be reaching out to each other for payers to reach out to providers and vice versa, versa and figure out how we can serve our shared patients together. So that would be my final thought for today.
- [21:35]
A
Wonderful. Well, thank you both very much for taking the time to chat with us and for sharing your insights and all the latest that's going on at CalOptima. We really appreciate it.
- [21:45]
B
Thank you. Have a great rest of your week
- [21:47]
A
and to our audience. If you'd like to listen to more podcasts from Becker's, you can visit Beckershospitalreview.com.