September 2022

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MetroPlus Health Plan is a prepaid health service plan and a wholly owned subsidiary of NYC Health + Hospitals (H+H). MetroPlus contracts with H+H and other providers to offer Medicaid, Essential Plans, Child Health Plus (CHP), Medicare Advantage Plans, plans for eligible New York City employees and city agency day care workers, and more. of managed care healthcare services. We offer private plans for over 670,000 members through the NY State of Health (NYSOH, the state’s online marketplace). Changes to MetroPlus enrollment will have a direct impact on H+H’s financial stability. As more members choose H+H as their provider, hospital systems generate more revenue. This is a clear goal of our strategic plan. This overview provides an update on MetroPlus enrollment trends, as described in the report: NYC Health + Hospitals Check-Up: The Impact of COVID-19.

Pandemic impact on MetroPlus health insurance coverage

MetroPlus’ enrollment reached a record high of 670,915, an increase of 159,284 members (31%) between February 2020 and June 2022, affected by the COVID-19 pandemic ( (see Figure 1).

Figure 1 – Registration with MetroPlus

Approximately 70% of MetroPlus memberships are enrolled in mainstream Medicaid managed care plans, which experienced the largest actual membership growth among all plans offered. Enrollment in the Essential Plan, a subsidized basic health insurance plan offered through NYSOH, recorded the largest growth rate of all plans at 44% (see Figure 2). In late January 2020, the Secretary of the U.S. Department of Health and Human Services (HHS) declared COVID-19 a public health emergency (PHE). Demonstrates emergency flexibility to respond to crises. The federal Families First Coronavirus Response Act, enacted in March 2020, authorized financial relief to states that created a requirement to keep most beneficiaries continuously enrolled in Medicaid during PHE. The New York State Department of Health (DOH) allows people to remain enrolled in Medicaid, CHP, and Essential plans without annual renewals, but continues to enroll new eligible individuals. increase. This provision means that enrollment in these plans will likely continue to increase through her PHE, which is currently approved through mid-October 2022.

Figure 2 – MetroPlus subscriptions by plan type

Additionally, MetroPlus experienced an increase in market share in mainstream Medicaid Managed Care and Essential Plan enrollments in the city. MetroPlus’ share of citywide enrollments in mainstream Medicaid managed care plans, covering the largest share of members, increased from 14.8% in February 2020 to 15.8% in June 2022. His third largest project in the city. Enrollments for these plans increased 34%, and enrollments for all other Medicaid managed care plans offered in the City increased 24%. MetroPlus’ share of Citywide enrollments in the Essential Plan increased from approximately 17% to 19% over the same period.

MetroPlus Financial and Operational Impact on NYC Health + Hospitals

H+H’s financial stability is impacted by MetroPlus’ ability to continue to attract new members and retain current members while focusing on better care management. To maximize revenue from MetroPlus, H+H will increase members’ use of H+H’s health services and engage members in regular chronic disease management to avoid unnecessary high-cost usage. We are working with MetroPlus to make it happen. Additionally, to address the needs of her MetroPlus members who are frequent hospital users at H+H, members will have access to comprehensive care management, including services that address their medical, social, and behavioral health needs. We are also taking steps to ensure that For example, in 2017 MetroPlus and H+H established a housing task force to connect H+H patients in need of affordable and supportive housing, including MetroPlus members. Over 300 of her MetroPlus members were accommodated as a result. Increased access to primary and specialty care services by insured persons at H+H medical facilities directly supports H+H’s strategic plan for financial stability.

Despite the efforts of MetroPlus and H+H, the majority of MetroPlus members use providers other than H+H. The percentage of MetroPlus spending at H+H facilities decreased from 40% in FY2019 to 39.1% in FY2021 and recovered to 42.6% in FY22, but still falls short of the H+H target of 45%. Not yet (see Figure 3).

Figure 3 – MetroPlus healthcare spending share in H+H

As part of its outreach efforts to attract new members, MetroPlus will help individuals who are ineligible or unable to afford insurance through a financial assistance program that offers a wide range of healthcare services on a sliding scale at H+H facilities. It directs you to a certain NYC Care program. cost.

In line with DOH’s efforts to reform Medicaid payments statewide, H+H and MetroPlus entered into an agreement to move away from a volume-based reimbursement model to encourage reimbursements based on quality and cost-effectiveness of care. I called. In this value-based payment (VBP) arrangement, H+H covers all eligible patients within his VBP arrangement, even if that care is provided outside the H+H system. must bear the medical risk of the services of MetroPlus will pay H+H after settling any remaining net amount after paying all medical expenses associated with the VBP contract. Risk-sharing liability was $199 million and $428 million for fiscal 2021 and 2020, respectively.

In 2020, During the First Wave of the COVID-19 Pandemic, MetroPlus Ranked Highest Among 15 Medicaid Managed Care Plans Statewide in DOH’s Quality Incentive Program, which Evaluates Performance Covering a Wide Range of Quality Scales attached.

Convergence of the Federal Public Health Emergency

When the PHE expires, the provisions for continued registration terminate, as do any other registration flexibility granted during the PHE term. Federal guidance requires the DOH to return to normal eligibility and registration practices and complete all renewals within her 14 months. This is a difficult process as Medicaid enrollment has reached record levels and renewals have not been processed in almost two and a half years. In preparation for PHE retirement, the state is providing tools to help interested parties notify policyholders about policy renewals. MetroPlus has developed a strategy for member education and outreach to sustain the enrollment growth achieved during the pandemic. Enrollment in these plans may decrease when the member renewal process returns to normal procedures, and some members may not renew or be ineligible for coverage. However, the state’s FY2023 enactment budget includes provisions that expand the eligibility of public health plans offered through MetroPlus.

If MetroPlus is successful in adding new eligible Members to the Plan, it may offset any potential loss of enrollment. MetroPlus enrollments are at unprecedented levels, which will be difficult to sustain during the PHE pullback period. MetroPlus is working with H+H to facilitate rapid re-enrollment for those who remain eligible for Medicaid re-enrollment and to move those who are no longer eligible to Essential Plan coverage. is. MetroPlus will facilitate these transitions by effectively using public benefits data and eligibility flexibility that remain available from the federal government to maintain member coverage and prevent lapses in care. We are reaching out to city and state partners to help. Continued collaboration with the State of New York remains critical to supporting this effort.

In addition, H+H must continue to provide quality care and strive to improve patient satisfaction, including reduced wait times for appointments, to continue to attract MetroPlus members. These efforts will allow H+H to work towards his goal of 45% of MetroPlus’ healthcare costs and successfully execute its strategic plan.

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