MCS executives will join industry experts in the 2019 Puerto Rico Health Insurance Conference on April 5 to discuss from the private sector’s perspective some of the most controversial challenges impacting the industry, and how they can be addressed, organizers announced.
In response to the many challenges stemming from current federal underfunding policies, the healthcare industry is looking into creative managed care models, healthcare legislation, bending the cost curve and pursuing key policy changes aimed at improving provider compensation, quality care and funding for Puerto Rico’s healthcare programs, to maneuver through today’s rapidly-changing healthcare landscape and overcome the challenges lying ahead.
Among them, the importance of the Managed Care Model to lower cost, increase quality and provide access to healthcare services; The Medicaid and Medicare Advantage underfunding, the importance of accurate metrics for the Puerto Rico healthcare cause; and the federal government administration’s Blueprint and its implications for pharmaceutical coverage in the U.S. mainland versus Puerto Rico.
MCS executives Jim O’Drobinak, president, Roberto Pando and Carolyn Rodríguez will join other industry experts at the “2019 Puerto Rico Health and Insurance Conference” hosted by the Puerto Rico Chamber of Commerce.
One of the issues to be discussed is the managed care model’s potential to significantly improve access to health care and health outcomes for the senior population.
“It may also have the potential to reduce program costs. However, these goals can only be achieved if federal payment rates are set at appropriate levels. And that’s where the huge problem resides,” O’Drobinak said.
While CMS’ (The Centers for Medicare and Medicaid Services) Medicare Advantage (MA) 2020 Call Letter appears to maintain MA payments in Puerto Rico at their current levels, fundamental changes are still needed to eliminate long-standing federal funding inequities for the island’s health care system.
MA serves over 585,000 beneficiaries on the island, including 280,000 dual-eligible (also with Medicaid). However, MA payment rates have gone from 24% below the national average in 2011 to 43% below the average in 2019, said O’Drobinak.
“Three in four senior citizens in Puerto Rico rely on Medicare Advantage for their health care. Therefore, it is a vital program to ensure seniors can access the care they need,” he said. “While we appreciate CMS’ previous efforts to improve the treatment of providers and plans in Puerto Rico under Medicare payment formulas, we urge CMS’ leadership to provide a permanent solution for Puerto Rico’s underfunding crisis.”
“Doing so will better protect seniors’ access to care, fortify Puerto Rico’s health care infrastructure, and provide much-needed stability to the island’s economy,” he said. O’Drobinak will discuss the topic in greater detail during the conference.
Meanwhile, the federal government administration’s blueprint’s implications for pharmaceutical coverage in Puerto Rico is another issue that will be discussed at the conference.
Rodríguez will moderate the panel, where industry experts will explain how the Federal government’s Blueprint seeks to lower drug prices and reduce out-of-pocket costs. From the private sector’s point of view, Rodríguez said it represents a major operational challenge for insurance companies to implement Blueprint requirements, as it would entail the restructuring of a huge portion of the industry, which could take years.
“Facing this scenario, we will discuss the Trump administration proposals regarding price transparency, the pharmaceutical industry position regarding this topic, how drug wholesalers will tackle the drug pricing issue and what will be the actual impact to patients in Puerto Rico,” said Rodríguez.
Pando, for his part, reiterated that “although the federal health reform has made it a huge challenge to deliver cost-effective healthcare products and services, better data and metrics could positively affect Puerto Rico’s treatment under CMS programs.”
This issue will be discussed in greater detail in Pando’s panel along with other topics including the current Puerto Rico landscape regarding healthcare and some of the main issues concerning accurate health data production on the island.
“From our perspective, if we could fix healthcare funding disparities and finally have access to the same amount of financing as the U.S. mainland, we could implement cutting-edge innovations in the Puerto Rico marketplace with a focus on, for example, illness prevention, which could lead to significant cost-effectiveness,” O’Drobinak said.
“With better funding, we could implement additional wellness and clinical management programs targeted at helping people prevent disease and improve their quality of life. This will trigger a domino effect that in the end will result in more retention, feasible cost-effective products and services and a possible bending of the cost curve, while creating a healthier society,” he said.