1 00:00:00,240 --> 00:00:02,720 Imagine this. You're at the Swiss Hotel in 2 00:00:02,720 --> 00:00:06,399 Chicago surrounded by top executives from leading insurance 3 00:00:06,399 --> 00:00:08,099 companies and health systems. 4 00:00:08,480 --> 00:00:12,160 Welcome to Becker's Fall Pair Issues Roundtable, November 5 00:00:12,160 --> 00:00:13,859 4th through 6, 2024. 6 00:00:14,625 --> 00:00:17,345 Picture the excitement as you gather business cards 7 00:00:17,345 --> 00:00:20,005 from over 500 executive level attendees, 8 00:00:20,545 --> 00:00:22,164 building invaluable connections. 9 00:00:22,704 --> 00:00:25,345 Feel the energy as you participate in over 10 00:00:25,345 --> 00:00:29,285 26 educational sessions led by 90 elite speakers. 11 00:00:29,769 --> 00:00:32,969 Envision yourself engaging in lively discussions about new 12 00:00:32,969 --> 00:00:36,409 health plans, hospital at home models, behavioral health, 13 00:00:36,409 --> 00:00:37,549 and price transparency. 14 00:00:38,170 --> 00:00:41,690 Now imagine being inspired by keynotes from boxing 15 00:00:41,690 --> 00:00:45,045 legend, Sugar Ray Leonard, and 4 time NBA 16 00:00:45,184 --> 00:00:47,744 All Star, Chris Webber. Their stories will leave 17 00:00:47,744 --> 00:00:50,004 you motivated and ready to innovate. 18 00:00:50,384 --> 00:00:53,024 Don't miss out on this unique opportunity. Get 19 00:00:53,024 --> 00:00:55,204 registered today. Visit beckershospital 20 00:00:55,600 --> 00:00:56,100 hospitalreview.com 21 00:00:57,199 --> 00:00:59,039 and click on the events page to find 22 00:00:59,039 --> 00:01:02,820 the conference website. That's the beckers hospital review.com 23 00:01:03,600 --> 00:01:05,700 events page. See you in Chicago. 24 00:01:06,319 --> 00:01:08,719 Hello, everyone. This is Jacob Emerson with the 25 00:01:08,719 --> 00:01:10,180 Becker's Healthcare Podcast. 26 00:01:10,564 --> 00:01:12,564 Thrilled today to be joined by a very 27 00:01:12,564 --> 00:01:13,465 special guest. 28 00:01:13,844 --> 00:01:16,825 George Halverson is the chairman at the Institute 29 00:01:16,885 --> 00:01:18,424 For Intergroup Understanding. 30 00:01:19,045 --> 00:01:21,364 George served as the CEO and chairman of 31 00:01:21,364 --> 00:01:23,465 Kaiser Permanente from 2,002 32 00:01:23,765 --> 00:01:24,504 to 2014. 33 00:01:25,130 --> 00:01:27,370 He previously served as a chair of AHIP, 34 00:01:27,370 --> 00:01:29,950 and he was also CEO of Health Partners 35 00:01:30,010 --> 00:01:30,750 in Minnesota. 36 00:01:31,290 --> 00:01:33,210 George, thank you so much for taking the 37 00:01:33,210 --> 00:01:34,650 time to be with me on the podcast 38 00:01:34,650 --> 00:01:35,150 today. 39 00:01:35,609 --> 00:01:36,829 Well, I am delighted, 40 00:01:37,290 --> 00:01:39,130 to be on the podcast. You you folks 41 00:01:39,130 --> 00:01:40,270 do a lot of good work 42 00:01:40,754 --> 00:01:41,155 and, 43 00:01:41,555 --> 00:01:43,575 have a lot of credibility 44 00:01:43,875 --> 00:01:45,394 in the world. So I I think that, 45 00:01:46,594 --> 00:01:47,974 I'm interested in actually, 46 00:01:49,155 --> 00:01:50,055 helping you 47 00:01:50,515 --> 00:01:51,655 maybe understand 48 00:01:52,114 --> 00:01:54,694 an important and relevant topic on 49 00:01:55,939 --> 00:01:57,540 that most people in the media are missing 50 00:01:57,540 --> 00:01:58,280 right now. 51 00:01:58,659 --> 00:01:59,159 So 52 00:02:00,500 --> 00:02:03,060 thank you for giving me the opportunity and 53 00:02:03,060 --> 00:02:05,140 the time and space to do that. Yeah. 54 00:02:05,140 --> 00:02:07,140 Absolutely. Well, we're we're excited to have you, 55 00:02:07,140 --> 00:02:09,655 and we're we're here today to talk about 56 00:02:09,715 --> 00:02:10,615 Medicare Advantage. 57 00:02:11,155 --> 00:02:13,495 Obviously, a huge topic and a lot of 58 00:02:13,715 --> 00:02:14,375 big changes, 59 00:02:14,675 --> 00:02:16,594 in the next few weeks for seniors all 60 00:02:16,594 --> 00:02:18,514 over the country. But before we dive into 61 00:02:18,514 --> 00:02:20,034 that, hoping you can tell us a little 62 00:02:20,034 --> 00:02:22,479 bit more about yourself, your background in health 63 00:02:22,479 --> 00:02:24,159 care for those that might not be familiar, 64 00:02:24,159 --> 00:02:26,020 and what it is that you're doing today 65 00:02:26,240 --> 00:02:28,419 at the Institute For Intergroup Understanding. 66 00:02:30,000 --> 00:02:31,300 I actually have 67 00:02:31,680 --> 00:02:32,180 spent 68 00:02:32,479 --> 00:02:34,979 quite a few years running health plans, 69 00:02:35,280 --> 00:02:37,060 health plans and hospital systems. 70 00:02:38,135 --> 00:02:39,034 Kaiser Permanente 71 00:02:39,495 --> 00:02:42,155 is a vertically integrated health plan clinic system, 72 00:02:42,615 --> 00:02:45,435 also a hospital system. Health Partners is also 73 00:02:46,295 --> 00:02:49,514 a vertically integrated care system and hospital system. 74 00:02:50,169 --> 00:02:52,250 And so I've spent a lot of time 75 00:02:52,250 --> 00:02:52,750 working 76 00:02:54,009 --> 00:02:54,669 with systems, 77 00:02:56,250 --> 00:02:56,750 financing, 78 00:02:58,889 --> 00:03:00,909 customers, and and basic 79 00:03:01,370 --> 00:03:04,250 health care delivery and financing for for quite 80 00:03:04,250 --> 00:03:04,829 a while. 81 00:03:05,514 --> 00:03:06,014 And, 82 00:03:07,435 --> 00:03:08,894 one of the things that 83 00:03:09,354 --> 00:03:10,894 I've worked on in in, 84 00:03:11,674 --> 00:03:12,894 both of those settings, 85 00:03:13,754 --> 00:03:14,254 was 86 00:03:14,634 --> 00:03:16,574 financing of the Medicare program. 87 00:03:17,689 --> 00:03:19,709 We, by the way, both of those settings, 88 00:03:19,769 --> 00:03:23,310 we computerized everything. We were completely and totally 89 00:03:24,090 --> 00:03:26,650 electronic at both Health Partners and Kaiser. We 90 00:03:26,650 --> 00:03:27,229 we did, 91 00:03:27,849 --> 00:03:29,389 the biggest epic implementation 92 00:03:29,689 --> 00:03:31,709 on the planet at the time we 93 00:03:32,165 --> 00:03:33,224 did it at Kaiser, 94 00:03:34,004 --> 00:03:34,585 a $3,000,000,000 95 00:03:35,844 --> 00:03:36,745 total project, 96 00:03:37,365 --> 00:03:39,925 and it worked extremely well. We went to 97 00:03:39,925 --> 00:03:42,264 a care system. It was completely and totally 98 00:03:43,284 --> 00:03:45,224 electronic at every level. 99 00:03:45,800 --> 00:03:48,040 And then we added to that, made it, 100 00:03:49,080 --> 00:03:50,780 accessible to patients electronically. 101 00:03:51,639 --> 00:03:54,520 And so during during COVID, Kaiser actually had 102 00:03:54,520 --> 00:03:56,620 about 80% of patient visits 103 00:03:57,159 --> 00:04:00,060 done electronically and and did it without even 104 00:04:00,764 --> 00:04:03,324 blinking because it was all the system that 105 00:04:03,324 --> 00:04:04,544 was already in place. 106 00:04:05,245 --> 00:04:07,084 So I've been in the systems world for 107 00:04:07,084 --> 00:04:08,305 a while. I've been in the 108 00:04:08,764 --> 00:04:09,264 computer 109 00:04:09,965 --> 00:04:10,465 rollout 110 00:04:10,844 --> 00:04:11,985 world for a while. 111 00:04:12,525 --> 00:04:15,405 And in the Medicare Advantage world, I go 112 00:04:15,405 --> 00:04:16,829 way back because the 113 00:04:19,129 --> 00:04:22,009 very first Medicare contracts that were done with 114 00:04:22,009 --> 00:04:22,669 a 95% 115 00:04:23,209 --> 00:04:23,709 capitation 116 00:04:25,289 --> 00:04:26,669 level were actually 117 00:04:27,209 --> 00:04:28,269 pilots in Minnesota. 118 00:04:30,164 --> 00:04:32,164 And Paul Ildwood and I actually went to 119 00:04:32,164 --> 00:04:34,345 Washington and negotiated those first 120 00:04:34,964 --> 00:04:35,464 95% 121 00:04:36,164 --> 00:04:37,704 contract decades ago. 122 00:04:38,644 --> 00:04:40,584 So this is not a new 123 00:04:41,284 --> 00:04:43,544 field for me, and I I think that 124 00:04:44,129 --> 00:04:44,870 we included 125 00:04:45,650 --> 00:04:48,550 Medicare Advantage in the Affordable Care Act 126 00:04:49,650 --> 00:04:52,930 when we put the process together so that 127 00:04:52,930 --> 00:04:54,310 it could actually 128 00:04:55,810 --> 00:04:56,310 finance 129 00:04:56,689 --> 00:04:57,189 Medicare 130 00:04:57,810 --> 00:05:00,115 and create a care system for Medicare that 131 00:05:00,115 --> 00:05:00,615 had 132 00:05:01,555 --> 00:05:02,455 lower costs, 133 00:05:03,235 --> 00:05:05,095 better care, and better benefits, 134 00:05:06,115 --> 00:05:09,314 and that has been fairly successful. Medicare Advantage 135 00:05:09,314 --> 00:05:10,615 is now over 136 00:05:11,550 --> 00:05:14,290 half of the population of the Medicare. 137 00:05:15,310 --> 00:05:16,689 It's been growing on 138 00:05:17,550 --> 00:05:20,350 a steady pace, and we're we're now at 139 00:05:20,350 --> 00:05:21,649 the point where 140 00:05:22,270 --> 00:05:24,129 not only is Medicare Advantage, 141 00:05:26,605 --> 00:05:28,544 the majority of members for Medicare, 142 00:05:29,564 --> 00:05:30,544 it's 70% 143 00:05:31,084 --> 00:05:32,544 of the African American 144 00:05:33,245 --> 00:05:34,305 members of Medicare. 145 00:05:35,324 --> 00:05:37,264 It's 80% of the Hispanic 146 00:05:38,125 --> 00:05:39,264 members of Medicare, 147 00:05:40,680 --> 00:05:42,860 and it is 90% 148 00:05:43,319 --> 00:05:45,500 of the lowest income members of Medicare. 149 00:05:47,000 --> 00:05:48,759 And one of the thing I've been very 150 00:05:48,759 --> 00:05:51,980 critical of MedPAC because MedPAC refuses to, 151 00:05:52,759 --> 00:05:54,220 discuss in their 152 00:05:54,854 --> 00:05:57,115 materials the income levels, the 153 00:05:57,735 --> 00:05:59,035 care improvement processes 154 00:05:59,495 --> 00:06:01,115 that happen in the various 155 00:06:01,814 --> 00:06:05,035 care settings. And what is absolutely true 156 00:06:05,735 --> 00:06:07,654 is that we have all of those low 157 00:06:07,654 --> 00:06:09,995 income people in Medicare Advantage 158 00:06:11,149 --> 00:06:13,730 because the care is so much 159 00:06:14,430 --> 00:06:14,930 better, 160 00:06:15,550 --> 00:06:17,410 and it is a lot cheaper. 161 00:06:18,110 --> 00:06:19,889 And right the way we finance 162 00:06:20,509 --> 00:06:21,009 Medicare 163 00:06:21,629 --> 00:06:22,129 Advantage 164 00:06:23,035 --> 00:06:25,055 is we take the average cost 165 00:06:25,355 --> 00:06:26,095 of Medicare 166 00:06:27,355 --> 00:06:28,415 in every county 167 00:06:28,875 --> 00:06:31,435 and then every year, the plans bid against 168 00:06:31,435 --> 00:06:32,574 that average cost. 169 00:06:33,194 --> 00:06:34,875 Those are real numbers. They've been around for 170 00:06:34,875 --> 00:06:36,495 a very while, long while. 171 00:06:37,379 --> 00:06:41,000 Everybody knows what those numbers are. The plans 172 00:06:41,139 --> 00:06:42,360 all bid 173 00:06:42,819 --> 00:06:43,319 below 174 00:06:43,699 --> 00:06:46,280 the average cost of Medicare every year. 175 00:06:47,699 --> 00:06:50,100 And the reason they bid below the average 176 00:06:50,100 --> 00:06:51,960 cost of Medicare every year 177 00:06:52,584 --> 00:06:55,084 is because the care is so much 178 00:06:55,865 --> 00:06:56,365 better 179 00:06:56,904 --> 00:06:57,805 in the plans. 180 00:07:00,264 --> 00:07:01,004 The plans 181 00:07:01,305 --> 00:07:03,964 know that you can reduce diabetic blindness 182 00:07:05,305 --> 00:07:06,444 by 60% 183 00:07:08,639 --> 00:07:10,740 by managing the blood sugar of patients. 184 00:07:11,360 --> 00:07:11,860 Absolutely. 185 00:07:12,560 --> 00:07:13,060 So 186 00:07:13,519 --> 00:07:15,759 all but that's the number one goal, quality 187 00:07:15,759 --> 00:07:18,399 goal in the Medicare Advantage quality program is 188 00:07:18,399 --> 00:07:19,459 blood sugar management. 189 00:07:19,919 --> 00:07:22,019 So we built that into the system intentionally 190 00:07:23,035 --> 00:07:24,334 to achieve that goal, 191 00:07:24,795 --> 00:07:25,855 and it's much 192 00:07:26,555 --> 00:07:27,055 cheaper 193 00:07:27,915 --> 00:07:30,394 to actually manage blood sugar. And, 194 00:07:31,035 --> 00:07:33,134 congestive heart failure, another example. 195 00:07:34,154 --> 00:07:34,814 The plans 196 00:07:35,290 --> 00:07:37,389 all identify who's at high risk of congestive 197 00:07:37,449 --> 00:07:39,050 heart failure, and then they work with those 198 00:07:39,050 --> 00:07:39,550 patients 199 00:07:40,250 --> 00:07:42,350 and bring down the cost of their 200 00:07:42,730 --> 00:07:44,330 care and their admissions, and they cut those 201 00:07:44,330 --> 00:07:45,710 admissions by over 40%. 202 00:07:46,330 --> 00:07:47,470 Absolutely. And amputations, 203 00:07:47,770 --> 00:07:49,449 I'll I'll just do the amputation real quick 204 00:07:49,449 --> 00:07:52,345 and we'll move out. But the amputation thing 205 00:07:52,345 --> 00:07:55,084 are amazing. The we do way, way, 206 00:07:55,464 --> 00:07:57,884 way too many amputations in this country. 207 00:07:58,504 --> 00:07:59,004 90% 208 00:07:59,545 --> 00:08:00,444 of the amputations 209 00:08:00,824 --> 00:08:02,285 are caused by 210 00:08:03,464 --> 00:08:04,205 foot ulcers. 211 00:08:04,990 --> 00:08:06,289 90% by foot ulcers. 212 00:08:06,990 --> 00:08:08,990 And we know that you could reduce the 213 00:08:08,990 --> 00:08:10,529 foot ulcers by 60% 214 00:08:12,349 --> 00:08:13,569 with clean socks 215 00:08:14,669 --> 00:08:15,649 and dry v. 216 00:08:16,509 --> 00:08:18,954 And so the plans all do that So 217 00:08:18,954 --> 00:08:20,634 the rest of the world has a much 218 00:08:20,634 --> 00:08:21,535 higher rate 219 00:08:21,995 --> 00:08:23,375 of of foot ulcers. 220 00:08:24,074 --> 00:08:24,894 Over a $100,000,000 221 00:08:25,194 --> 00:08:27,115 is spent by Medicare on foot ulcers right 222 00:08:27,115 --> 00:08:28,095 now each year. 223 00:08:28,714 --> 00:08:29,454 The plans 224 00:08:30,394 --> 00:08:32,235 have a very low number of foot ulcers, 225 00:08:32,235 --> 00:08:34,649 and they have very low numbers of amputations, 226 00:08:35,750 --> 00:08:37,830 and that is a lot cheaper. And so 227 00:08:37,830 --> 00:08:39,370 the plans bid 18% 228 00:08:40,710 --> 00:08:43,370 below the cost of fee for service Medicare, 229 00:08:45,029 --> 00:08:47,290 and those are real numbers because 230 00:08:47,670 --> 00:08:48,330 they manage 231 00:08:49,044 --> 00:08:49,865 the foot ulcers 232 00:08:50,165 --> 00:08:50,904 of the 233 00:08:52,085 --> 00:08:54,884 patients. Yes. And your points are so well 234 00:08:54,884 --> 00:08:58,085 taken, George. We've seen study after study showing 235 00:08:58,085 --> 00:09:01,605 that Medicare Advantage patients do see better health 236 00:09:01,605 --> 00:09:04,919 outcomes compared to fee for service Medicare across 237 00:09:04,919 --> 00:09:06,860 a wide variety of of conditions. 238 00:09:07,960 --> 00:09:10,379 To your to your earlier points, a majority 239 00:09:10,759 --> 00:09:13,659 of Medicare Advantage members, as of 2024 240 00:09:14,039 --> 00:09:16,024 are are making less than $25,000 241 00:09:16,884 --> 00:09:18,725 a year, so they are low income. It's 242 00:09:18,725 --> 00:09:19,625 a very diverse 243 00:09:20,325 --> 00:09:20,825 program. 244 00:09:21,204 --> 00:09:22,884 I don't have the exact percentages, but we 245 00:09:22,884 --> 00:09:24,105 know 2024 246 00:09:24,884 --> 00:09:27,125 is a lot of black, Latino, and and 247 00:09:27,125 --> 00:09:28,584 Asian Americans enrolled 248 00:09:28,964 --> 00:09:31,169 in this program. Then you also mentioned earlier, 249 00:09:31,169 --> 00:09:32,610 it is it is now the majority of 250 00:09:32,610 --> 00:09:35,250 the Medicare population. As of this year, Medicare 251 00:09:35,250 --> 00:09:36,949 Advantage now makes up 55% 252 00:09:37,409 --> 00:09:40,470 of of the Medicare population. That's almost 34,000,000 253 00:09:41,490 --> 00:09:43,889 people. So Yeah. I think my my natural 254 00:09:43,889 --> 00:09:46,415 question for you is during your time leading 255 00:09:46,415 --> 00:09:47,634 some of the the nation's, 256 00:09:49,054 --> 00:09:50,035 most largest, 257 00:09:51,295 --> 00:09:53,695 integrated health systems, both being the the hospital 258 00:09:53,695 --> 00:09:55,934 and the health plan, how did that experience 259 00:09:55,934 --> 00:09:58,539 shape your views on the Medicare Advantage Program 260 00:09:58,539 --> 00:10:00,460 going from being there from the beginning of 261 00:10:00,460 --> 00:10:02,639 the program until to where it is today? 262 00:10:04,059 --> 00:10:04,559 We 263 00:10:05,179 --> 00:10:08,639 very much appreciated the capitation cash flow, 264 00:10:09,375 --> 00:10:11,695 because when you get a capitation amount per 265 00:10:11,695 --> 00:10:13,615 patient, then you can use that resource to 266 00:10:13,615 --> 00:10:14,514 manage care 267 00:10:15,134 --> 00:10:16,835 of the patient. And Kaiser 268 00:10:17,375 --> 00:10:19,634 did spectacular work in 269 00:10:20,335 --> 00:10:20,835 reducing 270 00:10:21,215 --> 00:10:23,235 all of the complications of diabetes 271 00:10:23,535 --> 00:10:24,035 and 272 00:10:24,779 --> 00:10:25,519 chronic conditions. 273 00:10:27,259 --> 00:10:30,079 It has very low level of diabetic blindness 274 00:10:31,019 --> 00:10:33,899 because of that. And so I total I 275 00:10:33,899 --> 00:10:36,079 love that. I strongly encourage that. 276 00:10:36,379 --> 00:10:38,745 And what makes me a little crazy right 277 00:10:38,745 --> 00:10:40,585 now is that there are people at MedPAC 278 00:10:40,585 --> 00:10:42,585 and some other settings that are trying to 279 00:10:42,585 --> 00:10:45,565 cut the benefits of the Medicare Advantage Program 280 00:10:46,345 --> 00:10:47,565 and cut those benefits. 281 00:10:49,465 --> 00:10:51,644 And chair MedPAC actually said that 282 00:10:52,429 --> 00:10:55,409 it's unfair to higher income white people 283 00:10:55,789 --> 00:10:57,649 to have to, buy 284 00:10:58,269 --> 00:11:00,370 supplemental coverage to get the same 285 00:11:01,549 --> 00:11:04,190 extensive benefits that the Medicare Advantage patients get 286 00:11:04,190 --> 00:11:04,850 for free. 287 00:11:05,445 --> 00:11:07,304 And he wrote that in a 288 00:11:08,725 --> 00:11:11,125 paper. Right. It makes me crazy because I 289 00:11:11,125 --> 00:11:12,504 worked with in Minnesota, 290 00:11:12,965 --> 00:11:14,904 we worked with the lowest income 291 00:11:15,605 --> 00:11:18,085 population, and I I actually ran senior health 292 00:11:18,085 --> 00:11:19,304 plan for a short while, 293 00:11:20,529 --> 00:11:22,529 before running health partners. And so I've been 294 00:11:22,529 --> 00:11:24,790 in the this for a very long time. 295 00:11:25,250 --> 00:11:26,549 Why do you think that is, George? 296 00:11:27,250 --> 00:11:29,570 What you're saying saying about MedPAC? Is this 297 00:11:29,570 --> 00:11:31,190 is this all come down to politics? 298 00:11:31,570 --> 00:11:33,570 What what's what's the reasoning behind what you're 299 00:11:33,570 --> 00:11:34,605 saying in terms of, 300 00:11:35,084 --> 00:11:37,644 what MedPAC is writing about the Medicare Advantage 301 00:11:37,644 --> 00:11:38,144 Program? 302 00:11:38,445 --> 00:11:41,245 That's that's fascinating. I have pleaded with them. 303 00:11:41,245 --> 00:11:43,485 I have sent them all kinds of data. 304 00:11:43,485 --> 00:11:44,544 I've sent them information. 305 00:11:44,924 --> 00:11:46,304 I've sent them all the Medicare 306 00:11:47,059 --> 00:11:49,459 data. I've actually said to some of the 307 00:11:49,459 --> 00:11:50,519 the leaders there, 308 00:11:50,899 --> 00:11:53,220 so many people are losing their limbs through 309 00:11:53,220 --> 00:11:56,179 amputations because you are steering people. You're not 310 00:11:56,179 --> 00:11:59,080 steering enough people into the special needs plans. 311 00:12:00,235 --> 00:12:03,115 When you pass and karma happens, there's a 312 00:12:03,115 --> 00:12:05,195 good chance that those people are gonna be 313 00:12:05,195 --> 00:12:07,674 standing there thinking, why did you make my 314 00:12:07,674 --> 00:12:08,495 life hell? 315 00:12:09,035 --> 00:12:09,615 I mean, 316 00:12:10,235 --> 00:12:12,955 so I mean, I've been pretty direct in 317 00:12:12,955 --> 00:12:16,009 my communications with them and had no impact 318 00:12:16,009 --> 00:12:16,990 at all. None. 319 00:12:17,529 --> 00:12:18,029 0. 320 00:12:18,490 --> 00:12:19,949 They continue to say 321 00:12:20,250 --> 00:12:23,529 the most recent report said that, Medicare Advantage 322 00:12:23,529 --> 00:12:24,429 cost 22% 323 00:12:24,809 --> 00:12:25,309 more 324 00:12:26,169 --> 00:12:28,190 than the average cost of Medicare, 325 00:12:28,835 --> 00:12:30,355 and they put they put that in writing 326 00:12:30,355 --> 00:12:31,554 in the paper. And that gets quoted a 327 00:12:31,554 --> 00:12:33,315 lot. You guys quoted. Other guys quoted that 328 00:12:33,315 --> 00:12:34,535 22% number. 329 00:12:34,914 --> 00:12:35,975 It is a completely 330 00:12:36,274 --> 00:12:39,475 fictitious number. There's no when you've got 6a 331 00:12:39,475 --> 00:12:40,774 half 1000000 people 332 00:12:41,389 --> 00:12:43,169 with Medicare, Medicaid eligibility 333 00:12:43,870 --> 00:12:45,490 in the special needs plans, 334 00:12:46,590 --> 00:12:47,970 you can't get 22% 335 00:12:49,149 --> 00:12:49,889 risk skimming 336 00:12:50,590 --> 00:12:51,490 from the program. 337 00:12:52,269 --> 00:12:54,554 So just see it. Every year, I I'm 338 00:12:54,714 --> 00:12:56,174 I plead with them. I actually, 339 00:12:57,754 --> 00:12:59,454 depending who's in congress next, 340 00:12:59,754 --> 00:13:01,855 I might even be asking for impeachment, 341 00:13:04,954 --> 00:13:07,774 the leadership there because it is just crazy. 342 00:13:08,269 --> 00:13:10,190 Yeah. Okay. So, George, let me ask you 343 00:13:10,190 --> 00:13:12,690 about some of the criticisms we've heard from 344 00:13:12,830 --> 00:13:16,110 health system executives currently running some of the 345 00:13:16,110 --> 00:13:18,529 nation's largest largest hospital systems. 346 00:13:18,990 --> 00:13:21,085 They they often tell us about some of 347 00:13:21,085 --> 00:13:23,804 their issues with Medicare Advantage Carriers and and 348 00:13:23,804 --> 00:13:26,764 their relationships with them. They talk about restrictive 349 00:13:26,764 --> 00:13:29,184 provider networks. They talk about the prior authorization 350 00:13:29,245 --> 00:13:32,065 and other administrative hurdles they're they're often facing 351 00:13:32,529 --> 00:13:34,769 almost always with some of the large national 352 00:13:34,769 --> 00:13:35,269 carriers. 353 00:13:36,129 --> 00:13:37,750 We've seen all over the country, 354 00:13:38,529 --> 00:13:40,929 large health systems pouring down some of their 355 00:13:40,929 --> 00:13:43,909 Medicare Advantage contracts. We've seen some notable examples 356 00:13:44,289 --> 00:13:45,429 of large health systems, 357 00:13:45,809 --> 00:13:49,095 terminating all their Medicare Advantage contracts. Only a 358 00:13:49,095 --> 00:13:51,995 few examples, but certainly among some large systems. 359 00:13:52,534 --> 00:13:54,294 So, how do you respond to this to 360 00:13:54,294 --> 00:13:56,855 this trend and to these criticisms and are 361 00:13:57,174 --> 00:13:58,695 what what can be what can be done 362 00:13:58,695 --> 00:14:01,939 to address these issues that health systems are 363 00:14:01,939 --> 00:14:04,039 are seen as being very real? 364 00:14:04,980 --> 00:14:07,459 Well, the a very, very, very small number 365 00:14:07,459 --> 00:14:09,319 of health systems are finding those 366 00:14:10,019 --> 00:14:11,860 problems to be real. When when you look 367 00:14:11,860 --> 00:14:12,519 at Optum, 368 00:14:13,254 --> 00:14:15,434 Optum right now has 50,000 369 00:14:16,774 --> 00:14:18,314 contracted care providers, 370 00:14:19,735 --> 00:14:21,115 and they have 371 00:14:23,495 --> 00:14:24,634 less than a 10% 372 00:14:25,975 --> 00:14:27,434 even delay process 373 00:14:28,299 --> 00:14:29,120 on the referrals 374 00:14:30,299 --> 00:14:33,019 because they want their caregivers to do well, 375 00:14:33,019 --> 00:14:35,179 and and they use care protocols to to 376 00:14:35,179 --> 00:14:36,000 get to the 377 00:14:36,540 --> 00:14:37,360 right outcomes. 378 00:14:37,660 --> 00:14:39,120 And so it's 379 00:14:40,664 --> 00:14:41,725 there are some 380 00:14:42,024 --> 00:14:42,524 plans 381 00:14:43,065 --> 00:14:45,404 that have performed at lower levels, 382 00:14:46,345 --> 00:14:47,725 but the major players 383 00:14:48,024 --> 00:14:51,644 are doing amazing. Look at their satisfaction levels. 384 00:14:51,865 --> 00:14:54,669 95% in 2020 4 across the board. Exactly 385 00:14:54,669 --> 00:14:56,289 when you spend 95 satisfaction 386 00:14:57,309 --> 00:14:58,929 You're doing a really good job 387 00:14:59,710 --> 00:15:01,950 They know their plan is to have the 388 00:15:01,950 --> 00:15:04,750 members love them. Their plan is to have 389 00:15:04,750 --> 00:15:05,490 the members 390 00:15:06,164 --> 00:15:08,985 bonding with them the the optimum assigns 391 00:15:10,325 --> 00:15:10,825 a 392 00:15:11,284 --> 00:15:11,784 nurse, 393 00:15:12,804 --> 00:15:14,184 to the diabetic patients 394 00:15:14,565 --> 00:15:15,144 to study 395 00:15:16,084 --> 00:15:18,804 Berwick actually said that those nurses are there 396 00:15:18,804 --> 00:15:19,464 to upcode 397 00:15:20,600 --> 00:15:22,220 He's written that three times. 398 00:15:23,399 --> 00:15:24,460 He said the nurses 399 00:15:25,000 --> 00:15:27,559 that the that Optum sends into the homes 400 00:15:27,559 --> 00:15:29,800 are there at Up, which is just BDS 401 00:15:29,800 --> 00:15:33,160 at the most monumental level because Optum really 402 00:15:33,160 --> 00:15:35,160 wants to deliver great care because they know 403 00:15:35,160 --> 00:15:35,865 they can get 404 00:15:36,745 --> 00:15:38,125 profit, good profit 405 00:15:38,664 --> 00:15:39,164 from, 406 00:15:40,264 --> 00:15:42,924 spending less than the capitation amount that's there, 407 00:15:43,304 --> 00:15:43,804 and 408 00:15:44,664 --> 00:15:46,424 they they make so much money on each 409 00:15:46,424 --> 00:15:48,664 of the patients. They wanna keep them there 410 00:15:48,664 --> 00:15:49,164 forever. 411 00:15:50,450 --> 00:15:53,169 They wanna keep them enrolled permanently enrolled. They 412 00:15:53,169 --> 00:15:55,190 wanna have a very highest decanis level. 413 00:15:55,570 --> 00:15:57,809 And and so the there are there's a 414 00:15:57,809 --> 00:15:59,029 small subset of 415 00:15:59,809 --> 00:16:02,149 plans that have a small subset of problems, 416 00:16:02,210 --> 00:16:05,455 but that's not the business model. Yeah. That's 417 00:16:05,455 --> 00:16:07,855 a great point. Tens of thousands of contracts. 418 00:16:07,855 --> 00:16:09,774 It is a only in the dozens of 419 00:16:09,774 --> 00:16:12,035 of health systems making these types of decisions. 420 00:16:12,254 --> 00:16:14,335 So you are you are correct. Very, very 421 00:16:14,335 --> 00:16:15,075 small percentage. 422 00:16:15,519 --> 00:16:15,679 Yes. 423 00:16:16,480 --> 00:16:18,799 You mentioned upcoding, and, you know, this has 424 00:16:18,799 --> 00:16:22,080 also been a, a highly scrutinized issue within 425 00:16:22,080 --> 00:16:22,740 the media. 426 00:16:23,679 --> 00:16:26,179 But we have also seen the federal government 427 00:16:26,240 --> 00:16:27,700 accuse or settle 428 00:16:28,095 --> 00:16:28,754 this issue, 429 00:16:29,134 --> 00:16:31,294 with most of the major carriers over the 430 00:16:31,294 --> 00:16:32,355 last few decades, 431 00:16:33,454 --> 00:16:35,554 in terms of inflating or potentially 432 00:16:36,174 --> 00:16:38,595 inflating risk scores to receive higher payments 433 00:16:38,975 --> 00:16:41,899 from the government. We've seen Medicare Advantage executives 434 00:16:41,899 --> 00:16:44,379 be indicted by the DOJ over this very 435 00:16:44,379 --> 00:16:44,879 issue. 436 00:16:45,740 --> 00:16:47,580 So so what do you make of this 437 00:16:47,580 --> 00:16:50,059 issue, and are what steps should be taken 438 00:16:50,059 --> 00:16:51,920 to ensure program integrity? 439 00:16:52,384 --> 00:16:53,044 Yeah. That's, 440 00:16:54,304 --> 00:16:55,845 this team at CMS 441 00:16:56,144 --> 00:16:57,524 did that 3 years ago. 442 00:16:58,225 --> 00:17:00,865 They literally chained. They eliminated all those old 443 00:17:00,865 --> 00:17:03,904 coding systems. You cannot upcode today. A plan 444 00:17:03,904 --> 00:17:05,924 cannot upcode today at all 445 00:17:06,359 --> 00:17:09,099 because the all the data on the diagnosis 446 00:17:09,400 --> 00:17:10,619 comes from the encounters. 447 00:17:11,480 --> 00:17:14,519 It's an encounter report. It's no plan reporting 448 00:17:14,519 --> 00:17:17,339 at all. And the encounter reports are extremely 449 00:17:17,559 --> 00:17:18,059 accurate. 450 00:17:18,544 --> 00:17:21,025 So when they audited those last year, they 451 00:17:21,025 --> 00:17:21,845 found 95% 452 00:17:22,144 --> 00:17:22,644 accuracy 453 00:17:23,025 --> 00:17:25,044 on on, higher than that actually, 454 00:17:25,664 --> 00:17:27,924 on the upcoding. So that has been eliminated. 455 00:17:28,224 --> 00:17:30,484 The upcoding issue is not possible 456 00:17:31,025 --> 00:17:34,085 because CMS eliminated the coding system 457 00:17:34,759 --> 00:17:37,079 and replaced it with a different access to 458 00:17:37,079 --> 00:17:40,220 the data that's based on the individual encounters 459 00:17:40,279 --> 00:17:42,679 filed by each person. Brilliant move by by 460 00:17:42,679 --> 00:17:43,179 CMS. 461 00:17:43,639 --> 00:17:45,659 Media has never mentioned it. 462 00:17:46,674 --> 00:17:49,154 The media has never mentioned what a huge 463 00:17:49,154 --> 00:17:50,214 change ad is. 464 00:17:50,914 --> 00:17:52,295 And even though CMS, 465 00:17:53,315 --> 00:17:55,795 was absolutely totally clear about it because it's 466 00:17:55,795 --> 00:17:56,375 the new 467 00:17:56,914 --> 00:17:58,055 world. So, 468 00:17:58,674 --> 00:18:01,299 that the answer, there were some plans that 469 00:18:01,299 --> 00:18:04,279 did some upcoding. They couldn't today because 470 00:18:05,859 --> 00:18:07,940 the encounter is the only source of that 471 00:18:07,940 --> 00:18:08,440 data. 472 00:18:08,740 --> 00:18:10,359 Sure. Absolutely. Absolutely. 473 00:18:10,980 --> 00:18:13,139 Yeah. So, George, we we, 474 00:18:13,460 --> 00:18:16,085 just we we were reporting about what the 475 00:18:16,085 --> 00:18:18,964 large carriers were discussing on their their last 476 00:18:18,964 --> 00:18:20,585 earnings calls with investors. 477 00:18:21,765 --> 00:18:23,845 Some of them, Aetna, Humana being the most 478 00:18:23,845 --> 00:18:26,884 notable examples, talking about rising rising costs within 479 00:18:26,884 --> 00:18:30,369 the senior population, rising utilization rates, especially as 480 00:18:30,369 --> 00:18:31,329 seniors come back, 481 00:18:32,049 --> 00:18:34,390 back into the health care ecosystem post pandemic. 482 00:18:35,009 --> 00:18:37,089 So what do you view as as the 483 00:18:37,089 --> 00:18:37,829 key challenges 484 00:18:38,130 --> 00:18:39,670 facing Medicare Advantage 485 00:18:40,130 --> 00:18:42,130 right now, and how can it continue to 486 00:18:42,130 --> 00:18:44,869 offer this high quality care while remaining 487 00:18:47,154 --> 00:18:48,454 cost effective? Well, 488 00:18:49,554 --> 00:18:50,674 I I think it, 489 00:18:51,154 --> 00:18:54,194 it it's relatively easy to maintain the high 490 00:18:54,194 --> 00:18:54,694 level 491 00:18:55,394 --> 00:18:58,115 of care while being cost effective because it's 492 00:18:58,115 --> 00:18:59,174 based on 493 00:19:00,150 --> 00:19:02,710 identifying the blood sugar to patients, identifying who's 494 00:19:02,710 --> 00:19:05,430 at high risk for congestive heart failure, getting 495 00:19:05,430 --> 00:19:07,590 the foot ulcers out of play. All of 496 00:19:07,590 --> 00:19:09,590 the things that drive the major costs are 497 00:19:09,590 --> 00:19:11,769 things that plans are gonna continue to do, 498 00:19:11,830 --> 00:19:13,830 and they're gonna have really good results with 499 00:19:13,830 --> 00:19:15,455 that, and they're all gonna work. The reason 500 00:19:15,455 --> 00:19:17,055 they're gonna work is because of their good 501 00:19:17,055 --> 00:19:17,555 care. 502 00:19:18,255 --> 00:19:20,734 I mean, a foot my best friend's mother 503 00:19:20,734 --> 00:19:23,055 has a foot ulcer right now. She is 504 00:19:23,055 --> 00:19:24,914 in so much pain. She wants to die. 505 00:19:25,454 --> 00:19:25,954 And, 506 00:19:26,414 --> 00:19:28,434 they're maybe gonna have an amputation. 507 00:19:28,950 --> 00:19:31,190 If she was in a Medicare Advantage plan, 508 00:19:31,190 --> 00:19:33,750 she wouldn't have that ulcer. She wouldn't have 509 00:19:33,750 --> 00:19:35,849 that health. She wouldn't have that lousy life. 510 00:19:36,470 --> 00:19:36,970 So 511 00:19:37,509 --> 00:19:38,649 I'm gonna try to, 512 00:19:39,589 --> 00:19:41,369 get her enrolled on a plan, but 513 00:19:41,755 --> 00:19:43,994 the plans are going to do just fine 514 00:19:43,994 --> 00:19:44,654 going forward 515 00:19:45,355 --> 00:19:48,654 because it's not about risk skimming. It's about 516 00:19:49,275 --> 00:19:50,015 care management. 517 00:19:50,794 --> 00:19:52,255 And Optum has, 518 00:19:53,849 --> 00:19:56,970 Optum stole the old Kaiser model of owning 519 00:19:56,970 --> 00:19:58,670 all the employing all the. 520 00:19:59,769 --> 00:20:01,630 Optum is now doing that themselves, 521 00:20:02,250 --> 00:20:03,470 and they studied 522 00:20:03,849 --> 00:20:06,089 Kaiser very closely as they went down that 523 00:20:06,089 --> 00:20:07,549 path and figured out which thing 524 00:20:08,009 --> 00:20:10,914 made sense. The model works. It's a really 525 00:20:10,914 --> 00:20:11,734 good model, 526 00:20:13,075 --> 00:20:15,015 and the doctors love it because 527 00:20:16,434 --> 00:20:18,615 they're all told to do the right thing. 528 00:20:19,474 --> 00:20:19,974 Absolutely. 529 00:20:20,515 --> 00:20:22,755 Yeah. I mean, they why do they do 530 00:20:22,755 --> 00:20:25,190 that? Because the leaders at Optum Optum know 531 00:20:25,490 --> 00:20:28,309 that their long term success and future 532 00:20:29,009 --> 00:20:31,109 is gonna depend on them 533 00:20:31,889 --> 00:20:32,389 delivering 534 00:20:33,409 --> 00:20:35,190 good care at a low cost 535 00:20:35,490 --> 00:20:37,190 and keeping the patient loyalty. 536 00:20:37,945 --> 00:20:40,125 So they it's like the computer companies 537 00:20:40,505 --> 00:20:41,484 that figured out 538 00:20:41,785 --> 00:20:42,845 our way of keeping 539 00:20:43,224 --> 00:20:45,484 customer loyalties by having a better computer. 540 00:20:45,785 --> 00:20:46,285 Sure. 541 00:20:46,744 --> 00:20:48,424 And they they literally use that as an 542 00:20:48,424 --> 00:20:51,164 example. I mean, the computer company succeeded by 543 00:20:51,305 --> 00:20:53,809 having better computer. We're gonna succeed by having 544 00:20:53,809 --> 00:20:56,130 better care. Yeah. So I I don't think 545 00:20:56,130 --> 00:20:57,970 that's gonna I don't think that's gonna change 546 00:20:57,970 --> 00:20:58,470 any, 547 00:20:59,410 --> 00:21:01,490 trajectory. If there was a different business model, 548 00:21:01,490 --> 00:21:03,410 it might, but not with the one we 549 00:21:03,410 --> 00:21:05,490 have now. Yeah. So, George, in terms of 550 00:21:05,490 --> 00:21:07,815 the headwinds that we do see some carriers 551 00:21:07,815 --> 00:21:09,575 talked about right now, you see those as 552 00:21:09,575 --> 00:21:10,075 temporary? 553 00:21:11,414 --> 00:21:12,855 Yeah. I see the I see those as 554 00:21:12,855 --> 00:21:15,174 temporary. And Mhmm. Well, I and I think, 555 00:21:15,575 --> 00:21:17,015 there there are people who are gonna 556 00:21:19,494 --> 00:21:20,714 if if they can 557 00:21:21,220 --> 00:21:23,220 get those numbers to a slightly higher number, 558 00:21:23,220 --> 00:21:24,340 they will Sure. 559 00:21:24,740 --> 00:21:26,360 Argue for it. But 560 00:21:27,380 --> 00:21:30,039 we also know that those numbers are 18% 561 00:21:30,900 --> 00:21:32,900 below the average cost of fee for service 562 00:21:32,900 --> 00:21:33,880 Medicare now. 563 00:21:34,515 --> 00:21:37,315 If they go up to 12% below or 564 00:21:37,315 --> 00:21:39,174 10% below, they're still way below. 565 00:21:40,035 --> 00:21:42,355 They are so far below the average cost 566 00:21:42,355 --> 00:21:43,734 to fee for service Medicare 567 00:21:44,195 --> 00:21:46,375 with the current model that there's a huge 568 00:21:46,434 --> 00:21:48,615 amount of leeway before they get 569 00:21:49,075 --> 00:21:49,575 close 570 00:21:50,309 --> 00:21:52,569 to a danger point for the cause. 571 00:21:53,429 --> 00:21:53,929 Absolutely. 572 00:21:54,470 --> 00:21:56,250 And because it's capitation, 573 00:21:56,869 --> 00:21:58,789 the gover I I've capitated a bunch of 574 00:21:58,789 --> 00:22:00,630 plants. I actually started some of the first 575 00:22:00,630 --> 00:22:03,349 capitate plans Minnesota decades ago. I've done a 576 00:22:03,349 --> 00:22:04,649 lot of capitation deals. 577 00:22:05,065 --> 00:22:06,924 Capitation works really well. 578 00:22:07,384 --> 00:22:09,164 When you capitate a care system 579 00:22:09,465 --> 00:22:12,205 and pay them a fixed amount per patient, 580 00:22:12,424 --> 00:22:14,025 then they figure out the right thing to 581 00:22:14,025 --> 00:22:15,545 do for the patient. That's a that's a 582 00:22:15,545 --> 00:22:16,205 good model. 583 00:22:16,825 --> 00:22:18,825 And the beauty of it is then you 584 00:22:18,904 --> 00:22:20,205 you've got a fixed cost. 585 00:22:20,579 --> 00:22:22,599 Medicare now has a fixed cost 586 00:22:23,140 --> 00:22:25,400 on all of those Medicare Advantage patients. 587 00:22:26,659 --> 00:22:29,480 It can't go over the capitation level. 588 00:22:30,659 --> 00:22:32,579 So it's a permanent savings. It is a 589 00:22:32,579 --> 00:22:33,079 permanent 590 00:22:33,779 --> 00:22:34,759 win for Medicare. 591 00:22:35,734 --> 00:22:37,275 If you understand the model, 592 00:22:37,815 --> 00:22:38,715 the the, 593 00:22:39,414 --> 00:22:41,195 success is a permanent success. 594 00:22:41,734 --> 00:22:42,234 And 595 00:22:42,615 --> 00:22:44,234 if they go into the future 596 00:22:46,775 --> 00:22:49,015 and pressures come at them to bring those 597 00:22:49,015 --> 00:22:49,835 costs up, 598 00:22:50,509 --> 00:22:53,330 All Medicare has to do is stop 599 00:22:54,350 --> 00:22:54,850 increasing 600 00:22:55,390 --> 00:22:55,890 beyond 601 00:22:56,430 --> 00:22:58,130 the point that they want to pay. 602 00:22:59,150 --> 00:23:01,789 They have total control. Sure. Sure. They have 603 00:23:01,789 --> 00:23:03,549 almost no control on the fee side of 604 00:23:03,549 --> 00:23:05,890 the business. They have total control 605 00:23:06,404 --> 00:23:09,445 on the capitation side. Yeah. Well, and and 606 00:23:09,445 --> 00:23:12,164 to your earlier point, George, regarding Optum and 607 00:23:12,164 --> 00:23:14,805 and just their their sheer impressiveness and their 608 00:23:14,805 --> 00:23:17,545 goal of continuing to provide high quality care, 609 00:23:18,660 --> 00:23:19,160 UnitedHealth 610 00:23:19,460 --> 00:23:21,940 overall and Elavance are not among the major 611 00:23:21,940 --> 00:23:24,500 carriers talking about headwinds right now. They've they've 612 00:23:24,500 --> 00:23:26,740 been very open that they feel really good 613 00:23:26,740 --> 00:23:28,980 about the Medicare Advantage Program moving forward, that 614 00:23:28,980 --> 00:23:30,680 they've priced correctly, and, 615 00:23:31,224 --> 00:23:32,825 they they seem to be in the best 616 00:23:32,825 --> 00:23:34,825 position as we head into the annual enrollment 617 00:23:34,825 --> 00:23:35,325 period. 618 00:23:35,625 --> 00:23:37,384 Absolutely. They're they're gonna be huge 619 00:23:38,264 --> 00:23:39,244 yes. Absolutely. 620 00:23:40,184 --> 00:23:42,444 There there are I don't know who is 621 00:23:42,505 --> 00:23:43,804 complaining out there 622 00:23:44,490 --> 00:23:47,289 now, but whoever is complaining right now might 623 00:23:47,289 --> 00:23:48,029 not be 624 00:23:49,130 --> 00:23:51,230 they might not be a long term player. 625 00:23:53,289 --> 00:23:55,049 I don't know who they are, but what 626 00:23:55,049 --> 00:23:56,109 I know is 627 00:23:56,585 --> 00:23:58,825 the model works. And if you manage care 628 00:23:58,825 --> 00:24:01,244 against that model, you're gonna do well. Yeah. 629 00:24:01,625 --> 00:24:03,944 And there are CFOs who will argue, you 630 00:24:03,944 --> 00:24:05,484 know, try to get the number up. 631 00:24:05,944 --> 00:24:06,444 But 632 00:24:07,545 --> 00:24:09,660 if the number is still based on a 633 00:24:09,660 --> 00:24:11,820 discount from the average cost of fee for 634 00:24:11,820 --> 00:24:12,320 service, 635 00:24:12,859 --> 00:24:15,840 even there, it's gonna cost less. Yeah. Absolutely. 636 00:24:16,460 --> 00:24:19,279 So, George, the the Medicare Advantage enrollment growth, 637 00:24:19,340 --> 00:24:21,180 it's not gonna be slowing down. We know 638 00:24:21,180 --> 00:24:23,180 it's gonna continue to grow in terms of 639 00:24:23,180 --> 00:24:25,734 the percentage of of the overall Medicare population. 640 00:24:25,955 --> 00:24:27,875 So where do you view the role of 641 00:24:27,875 --> 00:24:30,115 the program evolving over the next, let's say, 642 00:24:30,115 --> 00:24:32,615 5 to 10 years as more seniors opt 643 00:24:32,835 --> 00:24:35,815 for Medicare Advantage over fee for service Medicare? 644 00:24:36,195 --> 00:24:38,650 Well, the benefits are far, far, far better 645 00:24:38,650 --> 00:24:42,009 with Medicare Advantage. And and here's a really 646 00:24:42,009 --> 00:24:42,910 important point. 647 00:24:43,690 --> 00:24:46,509 Our retirement programs in this country are terrible. 648 00:24:46,970 --> 00:24:48,809 Over half of the people don't have a 649 00:24:48,809 --> 00:24:49,309 retirement 650 00:24:49,769 --> 00:24:52,029 plan, pension plan of any kind. 651 00:24:52,914 --> 00:24:54,214 And so they're 652 00:24:55,075 --> 00:24:57,494 getting to the old age and retiring 653 00:24:58,355 --> 00:25:00,695 and have no resources, no assets. 654 00:25:01,154 --> 00:25:03,575 The average Hispanic family has less than $20,020,000 655 00:25:05,474 --> 00:25:05,974 in 656 00:25:06,434 --> 00:25:07,815 net assets at retirement. 657 00:25:08,599 --> 00:25:11,099 So when you get to the 658 00:25:11,799 --> 00:25:13,660 retirement time, Medicare Advantage 659 00:25:15,480 --> 00:25:16,940 has vision benefits, 660 00:25:17,640 --> 00:25:20,140 and Medicare Advantage has dental benefits, 661 00:25:21,015 --> 00:25:21,755 and Medicare 662 00:25:22,134 --> 00:25:23,835 Advantage has hearing benefits. 663 00:25:24,934 --> 00:25:27,355 And when you need dental care 664 00:25:28,535 --> 00:25:31,095 and you don't have Medicare Advantage, you're screwed. 665 00:25:31,095 --> 00:25:33,095 You there's where do you go for dental 666 00:25:33,095 --> 00:25:34,855 care? That's a great point. You're not gonna 667 00:25:34,855 --> 00:25:36,706 find a dentist. You're totally But if you 668 00:25:36,759 --> 00:25:39,880 or Medicare Advantage Plan, not only do you 669 00:25:39,880 --> 00:25:41,579 have that benefit, 670 00:25:43,000 --> 00:25:45,960 you also have it with a requirement that 671 00:25:45,960 --> 00:25:47,019 they know the language. 672 00:25:48,615 --> 00:25:50,775 I mean, that is so spectacular. The the 673 00:25:50,775 --> 00:25:51,215 level 674 00:25:51,654 --> 00:25:54,454 the Medicare Advantage System is far, far, far 675 00:25:54,454 --> 00:25:54,954 superior 676 00:25:55,414 --> 00:25:56,474 at many levels 677 00:25:57,335 --> 00:25:59,674 to not being in the in the program. 678 00:26:00,214 --> 00:26:01,974 And so I I think what's gonna happen 679 00:26:01,974 --> 00:26:03,815 is those benefits are gonna continue to be 680 00:26:03,815 --> 00:26:06,569 enriched, and all of those benefits are free. 681 00:26:07,429 --> 00:26:09,750 The dental benefit free to the Medicare trust 682 00:26:09,750 --> 00:26:10,250 fund. 683 00:26:10,789 --> 00:26:12,569 There is not 1p because 684 00:26:13,269 --> 00:26:14,009 it comes 685 00:26:14,390 --> 00:26:15,289 after the capitation. 686 00:26:16,444 --> 00:26:18,204 The trust fund is only affected by the 687 00:26:18,204 --> 00:26:19,265 capitation payment. 688 00:26:19,804 --> 00:26:22,125 So after that, it's all free to the 689 00:26:22,125 --> 00:26:22,865 trust fund. 690 00:26:23,244 --> 00:26:25,424 So the fact that we have dental benefits 691 00:26:25,644 --> 00:26:27,744 now, vision benefits, hearing benefits 692 00:26:28,204 --> 00:26:29,724 for a lot of people and some a 693 00:26:29,724 --> 00:26:32,690 number of social and the Medicare special needs 694 00:26:32,690 --> 00:26:34,389 plans are absolutely 695 00:26:34,690 --> 00:26:35,190 spectacular. 696 00:26:35,730 --> 00:26:37,009 They are the best thing we are doing 697 00:26:37,009 --> 00:26:38,929 in this country right now for low income 698 00:26:38,929 --> 00:26:41,889 high need people. Yeah. They're Medicare eligible, Medicaid 699 00:26:41,889 --> 00:26:42,389 eligible. 700 00:26:42,929 --> 00:26:43,065 And 701 00:26:44,904 --> 00:26:46,125 And they're booming and gross. They're they are 702 00:26:46,264 --> 00:26:48,825 growing. That's the fastest part of Medicare growing 703 00:26:48,825 --> 00:26:50,264 right now. Yep. We've got 6 and a 704 00:26:50,264 --> 00:26:52,664 half 1000000 people in them. And the reason 705 00:26:52,664 --> 00:26:53,724 that that's good 706 00:26:54,264 --> 00:26:56,549 and the and the Medicare trustees love it, 707 00:26:56,549 --> 00:26:59,429 and the Medicare CMS loves it because they 708 00:26:59,429 --> 00:27:01,750 are really getting good care in the special 709 00:27:01,750 --> 00:27:02,569 needs plans. 710 00:27:03,109 --> 00:27:05,190 And we need if we care about our 711 00:27:05,190 --> 00:27:06,730 older people who are in 712 00:27:07,190 --> 00:27:09,349 trouble, we want them to be in special 713 00:27:09,349 --> 00:27:10,169 needs plans. 714 00:27:11,284 --> 00:27:13,125 So that that's a really good place to 715 00:27:13,125 --> 00:27:16,244 be. So we're I think the special needs 716 00:27:16,244 --> 00:27:18,325 plans and I I think they're up now 717 00:27:18,325 --> 00:27:20,585 to 80% of the eligibles. 718 00:27:21,284 --> 00:27:21,784 Mhmm. 719 00:27:22,565 --> 00:27:23,304 And that 720 00:27:23,700 --> 00:27:26,279 should go to 90. There's some percentage are 721 00:27:26,339 --> 00:27:27,639 just gonna do it because 722 00:27:28,259 --> 00:27:30,119 it's just hard to figure out 723 00:27:30,899 --> 00:27:32,359 for some too 724 00:27:32,740 --> 00:27:35,319 too difficult probably for some people, but 725 00:27:35,619 --> 00:27:37,539 but I I think that everyone else is 726 00:27:37,539 --> 00:27:39,159 gonna be there. It's already 90. 727 00:27:39,515 --> 00:27:41,375 And and when you look at the satisfaction 728 00:27:41,434 --> 00:27:43,134 levels on the special needs plans, 729 00:27:43,434 --> 00:27:43,934 it's 730 00:27:44,235 --> 00:27:44,735 90% 731 00:27:45,115 --> 00:27:45,615 satisfaction. 732 00:27:46,715 --> 00:27:49,035 Think about that. Take the highest need, lowest 733 00:27:49,035 --> 00:27:49,934 cost people, 734 00:27:51,529 --> 00:27:52,429 and check their satisfaction 735 00:27:52,809 --> 00:27:54,809 level with their care and have it be 736 00:27:54,809 --> 00:27:55,549 over 90%. 737 00:27:56,250 --> 00:27:58,490 Yeah. What else in their world do they 738 00:27:58,490 --> 00:27:59,309 have that 739 00:28:00,490 --> 00:28:01,630 gives them a 90% 740 00:28:02,009 --> 00:28:04,904 level of of service? Yeah. No. It's it's 741 00:28:04,904 --> 00:28:06,184 a great point. And it is one, I 742 00:28:06,184 --> 00:28:07,944 think, to your point. It doesn't get discussed 743 00:28:07,944 --> 00:28:09,644 enough in terms of just the sheer 744 00:28:10,105 --> 00:28:12,024 growth we've seen in the dual special needs 745 00:28:12,024 --> 00:28:13,944 plans over these last few years. Like you 746 00:28:13,944 --> 00:28:15,944 said, George, it is the fastest growing piece 747 00:28:15,944 --> 00:28:17,039 of of the Medicare Advantage 748 00:28:17,660 --> 00:28:18,160 program. 749 00:28:18,619 --> 00:28:21,259 And that's the most important. It's really hugely 750 00:28:21,259 --> 00:28:24,079 important because most people really need it. Absolutely. 751 00:28:24,140 --> 00:28:25,920 They really need it. Yeah. 752 00:28:26,299 --> 00:28:27,839 Before we go, though, George, 753 00:28:28,299 --> 00:28:29,359 we hear your criticisms. 754 00:28:29,674 --> 00:28:31,355 We appreciate them. We've got a lot of 755 00:28:31,355 --> 00:28:34,154 health system leaders listening in. So your final 756 00:28:34,154 --> 00:28:36,335 thoughts, your final message that you wanna convey? 757 00:28:38,234 --> 00:28:40,634 We need to do continuous improvement in health 758 00:28:40,634 --> 00:28:43,134 care. We need to have system based care. 759 00:28:43,515 --> 00:28:44,849 We need to take 760 00:28:45,809 --> 00:28:48,309 the artificial intelligence tools that are available, 761 00:28:49,089 --> 00:28:51,089 use them against the database that we've got 762 00:28:51,089 --> 00:28:51,589 now, 763 00:28:52,049 --> 00:28:54,369 and put that all together into a package 764 00:28:54,369 --> 00:28:57,105 and end up with continuously improving care. And 765 00:28:57,105 --> 00:28:59,585 if we put all those pieces together, we 766 00:28:59,585 --> 00:29:01,924 should end up with far, far better care 767 00:29:02,464 --> 00:29:05,025 and less expensive care because it really does 768 00:29:05,025 --> 00:29:06,625 cause less when you don't have to do 769 00:29:06,625 --> 00:29:07,285 the amputation. 770 00:29:07,984 --> 00:29:10,625 So I I'd recommend everybody take a look 771 00:29:10,625 --> 00:29:11,845 at the total package 772 00:29:12,529 --> 00:29:14,389 of all of the tools with database 773 00:29:15,329 --> 00:29:17,990 and the artificial intelligence in the best practices 774 00:29:18,609 --> 00:29:19,889 and look forward to, 775 00:29:20,369 --> 00:29:23,809 delivering continuously improving care in every site in 776 00:29:23,809 --> 00:29:24,630 as a country. 777 00:29:25,724 --> 00:29:26,224 Fantastic. 778 00:29:26,525 --> 00:29:28,845 George, thank you so much for taking the 779 00:29:28,845 --> 00:29:30,525 time to be with me and for sharing 780 00:29:30,525 --> 00:29:33,085 your insights with our listeners. We truly appreciate 781 00:29:33,085 --> 00:29:33,585 it. 782 00:29:33,945 --> 00:29:35,705 Happy to do it. Thank you. If you'd 783 00:29:35,705 --> 00:29:37,945 like to listen to more podcasts from Becker's 784 00:29:37,945 --> 00:29:39,486 Health Care, you can visit beckershospitalreview.com.