Payers & Providers interviewed L.A. Care CEO John Baackes in its June 2019 California Edition's "Five Questions For..." section.
From Payers & Providers:
1: What are some relatively unique challenges for California healthcare going forward?
John Baackes: Because we are the largest state, everything that happens in California results in larger consequences. The most unique challenge right now is how we are preparing for the next recession. When the great recession occurred in 2008, there were nine million Californians covered by Medi-Cal. Now there are 13-and-a-half million as a result of the expansion in the Affordable Care Act. There is no doubt there will be another recession, and the state will probably have a contraction in tax revenues, which will likely have lawmakers looking at some reductions in Medi-Cal.
It's incumbent on those of us who are in the Medi-Cal managed care business to prepare for that. We must look back historically at what has happened in previous recessions— whether it was reduced benefits, reduced reimbursements or elimination of entire categories of beneficiaries. It seems to me that the most vulnerable category will be undocumented children up to age 19. The state took on that responsibility and may soon expand it through age 25. We should be thinking of ways we can take care of them when the recession hits.
As a plan, there is nothing that we can do to prevent the state from making cutbacks. We can only hope the state is doing all it can to make sure it has a robust rainy-day fund to get us through a recession. However, as an individual managed care Medi-Cal plan, we have to look at ways that we can reduce administrative costs to maintain reimbursement rates for our providers. I'm concerned that many of the providers who agreed to accept Medi-Cal patients after the ACA expansion will simply withdraw if a recession leads to cuts in reimbursements. We don't have enough primary care doctors or doctors in certain specialties now, so withdrawals would only exacerbate the problem. People would return to relying on emergency rooms for care.
2: What are the current challenges and opportunities for Medicaid health plans in California in 2019?
John Baackes: In addition to worrying about the future economy and its impact on Medicaid, we are dealing with changes in Medi-Cal benefits. We are launching the Health Homes Program in Los Angeles County. We already have Whole Person Care. And the state is proposing a change in how prescription drug benefits are administered. All of these things can be challenging, but they are also opportunities. We look at every one of them in terms of the impact on our members. We determine if it is going to improve the quality of care to members, or diminish it, and we respond accordingly.
Related to this, as the government issues new regulations, they start to pile up on each other and no one is doing an exhaustive look at the entire regulatory spectrum to determine if everything is compatible or if there is duplication that can be eliminated. It's also possible that there are things imposed decades earlier that don’t carry the same value anymore. Again, our goal in doing this sort of "inventory" would be to reduce the amount of administration that is required to participate in these Medi-Cal managed care programs so we don’t have to divert funds away from the providers who we need in the safety net.
3: How would you compare and contrast your past health plan executive experiences on the east coast with overseeing L.A. Care?
John Baackes: L.A. Care is unique in its own right, but unique in my experience, in that it is a health plan that is limited to one county. L.A. County happens to be bigger than 43 states and covers a huge geography. In the past, I worked at health plans that operated in multiple states. I welcome this change. It's a pleasure to only have to worry about one set of rules and regulations.
The other difference between L.A. Care and my experiences on the east coast is that this is a highly delegated model where the health plan is contracted with provider groups that we refer to as delegated entities. They entities have taken on a lot of the work that the health plans that I worked with previously did themselves. We are working with as many as 60 delegated entities, and we have discovered there is inconsistency in delivery. That has forced us to look at the delegated model and begin to hold the groups accountable to a set of performance standards to ensure our members have access to quality care, regardless of the medical group they have selected.
4: What special issue and challenges are there in providing health coverage in Los Angeles County?
John Baackes: We have a lot of medical resources in Los Angeles County, but they are not uniformly accessible. For example, we have deserts of provider availability in South L.A., the Antelope Valley, and the eastern San Gabriel Valley. This presents a particular challenge for L.A. Care. With one-fifth of the county enrolled in our health plan, we have people everywhere. Making sure that we have adequate access for everyone is a unique challenge to L.A. County.
5: Are there any recent initiatives or developments at L.A. Care that you're excited about and would like to share?
John Baackes: Since our member population lives and works in poverty, we have to be more aware of the social determinants that impact their ability to receive the right care in the right place at the right time. We are constantly looking for ways to channel safety net social services into their care. We know that social determinants are drivers of health care costs, so we have to make sure we address them.
In that regard, we are working jointly with Project Angel Food and the California Department of Health Care Services (DHCS) to provide medically-tailored meals to congestive heart failure patients to determine if those meals will affect their utilization of health care services. We hope to build up a database to show how these lower cost interventions can lead to better health outcomes and lower medical expenses.
L.A. Care has also committed $20 million over five years to Brilliant Corners, an organization that works with Los Angeles County's Housing for Health program to find housing for those experiencing homelessness in the county. The goal is to house 300 people, most of whom are L.A. Care members. 291 have already been housed.
The L.A. Care program with the greatest impact on accessibility is Elevating the Safety Net, a $31 million long-term initiative launched last year to address the growing physician shortage. The initiative consists of three programs. Under the Provider Recruitment Program, providers in the L.A. Care Medi-Cal network are eligible for grants to recruit primary care physicians into the L.A. County safety net. We have awarded 72 grants, and 45 new physicians have already been recruited.
The Physician Loan Repayment Program consists of grants to relieve outstanding medical school debt for those physicians who are recruited into the safety net. We will retire up to $180,000 in medical school debt if the physician agrees to stay in the safety net for three years. Eighteen physicians new to the L.A. County safety net are already benefiting from those grants.
The third program builds a physician pipeline into the safety net, by providing full medical school scholarships to students who have expressed an interest in working in underserved communities. Last year, we gave four scholarships to students who attended the David Geffen School of Medicine at UCLA and four to students who attended the Charles R. Drew University of Medicine and Science. We have just named eight new scholarship recipients.
About L.A. Care Health Plan
L.A. Care Health Plan serves nearly 2.2 million members in Los Angeles County, making it the largest publicly-operated health plan in the country. L.A. Care offers four health coverage plans including Medi-Cal, L.A. Care Covered™, L.A. Care Cal MediConnect Plan and the PASC-SEIU Homecare Workers Health Care Plan, all dedicated to being accountable and responsive to members. As a public entity, L.A. Care’s mission is to provide access to quality health care for L.A. County's low-income communities, and to support the safety net required to achieve that purpose. L.A. Care prioritizes quality, access and inclusion, elevating health care for all of L.A. County. For more information, follow us on Twitter, Facebook, LinkedIn, and Instagram.