February 23, 2024

The Q&A discussion (below) published in today’s Crain’s Health Pulse is a roadmap for the arguments the Health Plan Association and its members are making in response to several executive budget proposals that would impact their bottom line including Part AA – the commercial insurance rate mandate.

The number one argument we hear is that the commercial insurance mandate proposal ‘won’t work’ because we (our sub-sector) does not have the workforce to make the proposal a success.  What??

Regardless of the statement being made my answer is always the same:  Insurers have an obligation to pay fair rates for services provided through the public mental hygiene (in this case, the OASAS and OMH systems of care) to any/all New Yorkers regardless of the insurance card in their pockets.  When insurers are required to pay fair rates and do so in a timely manner,  we will be able to recruit and retain staff and offer competitive wages that can increase job satisfaction and increase the likelihood our staff can stay with us while also being able to put food on the table and meet other obligations.  Any argument that private practitioners can fill the tremendous access to care gaps around the state is (at best) unrealistic.  Insurers should not be permitted to avoid their responsibilities to establish and maintain robust networks of providers of ALL types.   Full stop.

Q&A: MetroPlusHealth exec on how to broaden insurance access after Hochul’s ‘mixed bag’ budget

JACQUELINE NEBER, 2/23/24 

Gov. Kathy Hochul’s executive budget includes several insurance proposals designed to increase New Yorkers’ access to health care. But Erin Drinkwater, the chief of government relations and strategic partnerships at MetroPlusHealth, is concerned that some of the policies could disrupt care access instead.

Drinkwater came to MetroPlusHealth, which is owned by New York City Health + Hospitals and covers more than 700,000 New Yorkers, after years at the city Department of Social Services. Her career has revolved around “making government work,” crafting policy and working within it to improve individuals’ social determinants of health and health outcomes. As such, she offered solutions to some of the challenges Hochul’s proposals aim to tackle, and ways for insurers that are part of the safety net to reach more people while keeping costs at bay.

Which proposals are you concerned about, and why?

The budget was a mixed bag, but we saw a lot of the same in terms of the executive looking at the safety net and where to find savings on the backs of the most vulnerable. We saw a 1% across-the-board [administrative rate cut for insurers], which is really concerning because we saw cuts to the rates over the summer. So it’s really, in addition to that, a 5% cut, which is quite significant. Plans like MetroPlusHealth are part of the safety net and play a crucial role in connecting our members to care. [Cuts] make it hard to recruit providers. We’ve had a huge focus [on] recruiting providers that reflect our members, recognizing that those things matter when people are seeking health care. When you have difficulty doing that, it impacts [peoples’ ability to engage].

There’s also a proposal about [eliminating] co-pays for insulin. I would challenge us as government: Is that the right focal point for an intervention around drug costs? No.

What about potential cuts to the Quality Incentive Program?

In the executive budget, she zeroed that out which was quite disappointing. Those are some of the most flexible dollars within the Medicaid program and they are dollars that passed through the plans directly to providers and community-based organization partners. These dollars allow providers to be able to extend office hours to weekends, making it an opportunity for people to go to the doctor who otherwise really can’t because of the confines of life. Providers use it to hire additional staff. Those are dollars that don’t just sit at the plans.

[The budget] sets up an unfortunate dynamic between the legislature and the executive in that it forces the legislature’s hand to have to buy the QIP back. It eliminates the opportunity for them to use that $268 million elsewhere for other programs and services.

The governor proposed requiring commercial insurers to pay at least the Medicaid rate for outpatient mental health and substance use services. Is that a solution to the state’s mental health challenges?

In the behavioral health space, I always think about the fact that if I am a provider,  and I can [charge] upwards of $400 for a private therapy appointment… Why am I going to choose to take a Medicaid rate of far less than that? There are some inherent problems that I think are very difficult to solve.

I think we need to pay more attention to the workforce shortages and think about how we are recruiting mental health practitioners who have a desire to work with the Medicaid population. I don’t think we’ve done a particularly focused job of thinking about people on the frontlines and the trauma they’ve experienced.

What has MetroPlusHealth done to work around these challenges?

We brought our behavioral health in-house. We now have teams of care coordinators and peer coordinators who are working directly with members working to make sure that they’re getting their treatments, whether that be inpatient care or management of the benefit. Prior to that we used a third-party provider.

For diabetes, we’re looking at prevention. What does it mean when a member comes to us and has precursors to a diabetes diagnosis? How can we focus on diet and exercise and other things to not move into that chronic condition that is so costly for the intervention? We [also] have an opportunity to use the power of government to really address the problem of pricing at the manufacturer level, and we’re not doing that.

Are you encouraged by any of the governor’s insurance proposals, and what can be done going forward?

We’re really excited that the governor included a continuous coverage proposal for children ages zero through six to remain enrolled in both Medicaid and the Children’s Health Insurance Program. But I want to be clear that choosing zero to six is a start. We should be looking at the full program and figuring out where there are changes that can be made to make the availability, and the ongoing access to the benefit, easier. We can foster healthy practices by taking the instability out [of coverage].