1 00:00:00,080 --> 00:00:02,159 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,159 --> 00:00:05,120 Becker's Payer Issues podcast. Thrilled today to be 3 00:00:05,120 --> 00:00:08,800 joined by CalOptima Health CEO, Michael Hahn. Michael, 4 00:00:08,800 --> 00:00:10,400 thanks so much for taking the time to 5 00:00:10,400 --> 00:00:11,939 be with me on the podcast today. 6 00:00:12,355 --> 00:00:14,754 Jacob, it's awfully nice to be here and 7 00:00:14,754 --> 00:00:16,295 really appreciate the invitation. 8 00:00:16,994 --> 00:00:18,835 Yeah. Likewise. I I appreciate you taking the 9 00:00:18,835 --> 00:00:19,954 time, Michael. And, 10 00:00:20,274 --> 00:00:21,714 we're here today to talk with you a 11 00:00:21,714 --> 00:00:24,274 little bit about the federal reconciliation bill, which, 12 00:00:24,274 --> 00:00:26,594 of course, as you know, was recently passed 13 00:00:26,594 --> 00:00:27,814 earlier this month. 14 00:00:28,579 --> 00:00:30,019 But before we dive into that and all 15 00:00:30,019 --> 00:00:32,260 the complexities involved in that bill for for 16 00:00:32,260 --> 00:00:34,340 your organization and and across the wider health 17 00:00:34,340 --> 00:00:35,000 care system, 18 00:00:35,380 --> 00:00:38,039 can you remind our listeners, what is CalOptima 19 00:00:38,179 --> 00:00:39,940 Health? Who do you serve, and and what 20 00:00:39,940 --> 00:00:40,440 markets, 21 00:00:40,899 --> 00:00:41,719 are you in? 22 00:00:42,454 --> 00:00:46,155 So, CalOptima Health serves the Medicaid 23 00:00:46,534 --> 00:00:49,594 population, which we refer to as Medi Cal 24 00:00:50,054 --> 00:00:52,234 here in Orange County, California. 25 00:00:52,935 --> 00:00:56,570 Orange County, California is the sixth largest county 26 00:00:56,630 --> 00:00:57,929 in The United States, 27 00:00:58,710 --> 00:01:00,570 here in the state of California. 28 00:01:01,270 --> 00:01:03,690 We currently are the third largest, 29 00:01:04,310 --> 00:01:06,730 Medicaid health plan in the state of California. 30 00:01:06,870 --> 00:01:07,609 We serve 31 00:01:08,144 --> 00:01:10,564 out of our 3,100,000 32 00:01:10,784 --> 00:01:11,844 member population, 33 00:01:12,625 --> 00:01:15,525 we serve about a million in the Medicaid 34 00:01:15,584 --> 00:01:17,604 program just here in Orange County. 35 00:01:17,984 --> 00:01:19,825 So what that means is that there are 36 00:01:19,825 --> 00:01:21,364 a million people out of 37 00:01:21,709 --> 00:01:23,709 3,000,000 or a third of the county that 38 00:01:23,709 --> 00:01:24,689 are low income 39 00:01:25,069 --> 00:01:27,709 or live below the federal poverty level here 40 00:01:27,709 --> 00:01:28,769 in Orange County. 41 00:01:29,149 --> 00:01:30,369 We're also a 42 00:01:30,909 --> 00:01:33,649 what's called a county organized health system. 43 00:01:34,114 --> 00:01:36,354 Back when we were founded thirty years ago 44 00:01:36,354 --> 00:01:37,894 in 1994, 45 00:01:38,114 --> 00:01:40,454 the county decided not to build, 46 00:01:41,155 --> 00:01:42,134 public hospitals. 47 00:01:42,594 --> 00:01:44,834 So we don't have a public hospital. We 48 00:01:44,834 --> 00:01:46,854 administer the Medi Cal program 49 00:01:47,680 --> 00:01:49,219 through about 10,000 50 00:01:49,599 --> 00:01:51,060 contracts with providers. 51 00:01:51,599 --> 00:01:54,659 That includes our doctors, our clinics, our hospitals, 52 00:01:55,200 --> 00:01:58,879 our skilled nursing facilities, our ambulatory centers, and 53 00:01:58,879 --> 00:02:00,099 our community clinics. 54 00:02:00,560 --> 00:02:02,979 So we are a county organized health system. 55 00:02:03,575 --> 00:02:04,635 We have a separate 56 00:02:05,255 --> 00:02:08,375 nine member fiduciary board. We are not part 57 00:02:08,375 --> 00:02:09,835 of the County Of Orange. 58 00:02:10,135 --> 00:02:12,694 We have a $4,700,000,000 59 00:02:12,694 --> 00:02:13,835 budget this year. 60 00:02:14,215 --> 00:02:15,094 90% 61 00:02:15,094 --> 00:02:17,995 of our revenues come from state tax revenues 62 00:02:18,480 --> 00:02:19,520 and 10% 63 00:02:19,520 --> 00:02:21,060 from CMS Medicare. 64 00:02:21,439 --> 00:02:24,020 So that's a little bit about CalOptima Health. 65 00:02:24,639 --> 00:02:27,360 Fantastic. Well, appreciate that overview and context for 66 00:02:27,360 --> 00:02:28,020 our listeners, 67 00:02:28,319 --> 00:02:28,819 Michael. 68 00:02:29,599 --> 00:02:31,599 Let's let's dive in and talk about HRM 69 00:02:31,599 --> 00:02:33,060 one, the the federal reconciliation 70 00:02:33,360 --> 00:02:36,175 bill that president Trump signed into law on 71 00:02:36,175 --> 00:02:37,074 July 4. 72 00:02:38,014 --> 00:02:40,254 Massive bill. So many different things we could 73 00:02:40,254 --> 00:02:41,634 talk about today. But, 74 00:02:42,174 --> 00:02:44,995 let's specifically focus on Medicaid where, 75 00:02:45,375 --> 00:02:49,080 it's anticipated that, Medicaid spending will decrease by 76 00:02:49,080 --> 00:02:50,759 nearly $1,000,000,000,000 77 00:02:50,759 --> 00:02:53,879 over the next decade. And, under that same 78 00:02:53,879 --> 00:02:56,300 timeline, we're expecting the uninsured population 79 00:02:56,919 --> 00:02:58,139 nationwide to, 80 00:02:58,680 --> 00:03:01,500 increase by an additional 10,000,000 people. 81 00:03:01,879 --> 00:03:03,925 And that's that's by 2034 82 00:03:03,925 --> 00:03:06,564 according to the Congressional Budget Office and their 83 00:03:06,564 --> 00:03:08,104 latest estimates. So, 84 00:03:08,965 --> 00:03:11,205 talk to us about the bill's impact on 85 00:03:11,205 --> 00:03:13,784 the operations and strategy at CalOptima, 86 00:03:14,900 --> 00:03:16,580 over over the next five to ten years? 87 00:03:16,580 --> 00:03:18,739 How are you thinking about this internally? How 88 00:03:18,739 --> 00:03:20,019 are you preparing for this, 89 00:03:20,419 --> 00:03:20,919 financially? 90 00:03:22,180 --> 00:03:23,080 So, Jacob, 91 00:03:23,459 --> 00:03:25,699 one of the things that is important for 92 00:03:25,699 --> 00:03:27,400 a lot of folks to understand 93 00:03:27,860 --> 00:03:31,114 right now is that all although HR one 94 00:03:31,114 --> 00:03:33,055 has been passed and we've got a state, 95 00:03:33,514 --> 00:03:36,074 budget that our governor signed into law as 96 00:03:36,074 --> 00:03:36,574 well, 97 00:03:37,354 --> 00:03:40,634 nothing yet has actually changed in either the 98 00:03:40,634 --> 00:03:41,134 services, 99 00:03:42,449 --> 00:03:43,430 or eligibility 100 00:03:43,969 --> 00:03:46,930 of any of our Medicaid members here, certainly 101 00:03:46,930 --> 00:03:49,430 in California and certainly here in Orange County. 102 00:03:49,969 --> 00:03:52,849 So the first messaging we're sending out is 103 00:03:52,849 --> 00:03:54,790 to our members letting them know, 104 00:03:55,245 --> 00:03:57,665 one, we haven't shared any of their confidential 105 00:03:57,805 --> 00:03:58,784 private information. 106 00:03:59,165 --> 00:03:59,665 Two, 107 00:04:00,125 --> 00:04:01,905 their benefits and their eligibility 108 00:04:02,685 --> 00:04:05,504 at this moment in time remains the same. 109 00:04:06,044 --> 00:04:07,425 And three, please, 110 00:04:07,950 --> 00:04:10,370 please, please go get your health care services. 111 00:04:10,510 --> 00:04:12,770 Take your kids in for baby well checks. 112 00:04:13,069 --> 00:04:14,129 Get your immunizations. 113 00:04:14,750 --> 00:04:17,889 Do your developmental screenings with your younger children. 114 00:04:18,430 --> 00:04:20,210 Make sure you're getting your pharmaceuticals 115 00:04:20,589 --> 00:04:21,569 for blood pressure 116 00:04:21,974 --> 00:04:24,074 and diabetes and whatever else, 117 00:04:24,534 --> 00:04:26,615 and make sure you're going to the doctor. 118 00:04:26,615 --> 00:04:27,834 And if you can't, 119 00:04:28,774 --> 00:04:30,454 or don't want to go to the doctor 120 00:04:30,454 --> 00:04:33,194 because you're concerned about things in the community, 121 00:04:34,229 --> 00:04:35,689 then try to use telehealth. 122 00:04:36,229 --> 00:04:38,490 We added on our website, 123 00:04:38,949 --> 00:04:40,470 caloptima.org 124 00:04:40,470 --> 00:04:40,970 backslash 125 00:04:41,509 --> 00:04:42,329 get care, 126 00:04:43,029 --> 00:04:45,930 a list of our physicians that do telehealth. 127 00:04:46,865 --> 00:04:49,904 So in preparing for the changes, first and 128 00:04:49,904 --> 00:04:52,144 foremost, we want people to continue to get 129 00:04:52,144 --> 00:04:55,664 their care until there is a change in 130 00:04:55,664 --> 00:04:57,444 the actual benefits eligibility 131 00:04:58,384 --> 00:04:59,125 and determinations. 132 00:05:00,220 --> 00:05:01,519 So the work eligibility, 133 00:05:02,060 --> 00:05:04,720 the soonest that that will start to occur 134 00:05:05,019 --> 00:05:05,919 for individuals 135 00:05:06,300 --> 00:05:09,040 that have to perform eighty hours a month 136 00:05:09,259 --> 00:05:10,240 for able-bodied 137 00:05:11,100 --> 00:05:12,480 adults without dependents 138 00:05:12,939 --> 00:05:14,800 under 14 years of age, 139 00:05:16,165 --> 00:05:19,324 Probably end of next year, so December 140 00:05:19,324 --> 00:05:20,405 2026, 141 00:05:20,404 --> 00:05:21,865 December 31, 142 00:05:22,404 --> 00:05:26,485 but no later than 12/31/2028. 143 00:05:26,485 --> 00:05:27,464 That's the mandate. 144 00:05:28,279 --> 00:05:30,279 And so one of the things we'll look 145 00:05:30,279 --> 00:05:33,339 at is making sure that our eligibility, 146 00:05:34,279 --> 00:05:36,939 which is determined by our social service agency, 147 00:05:38,279 --> 00:05:40,615 is kept up to date, And we, as 148 00:05:40,615 --> 00:05:43,094 the health plan, are aware of who is 149 00:05:43,094 --> 00:05:45,675 and is not eligible to receive services. 150 00:05:46,454 --> 00:05:48,154 So our initial preparation 151 00:05:48,534 --> 00:05:51,194 is, one, letting people know that right now, 152 00:05:51,654 --> 00:05:52,794 nothing has changed. 153 00:05:53,550 --> 00:05:56,290 Next, as we get ready to start implementing 154 00:05:56,990 --> 00:05:57,490 eligibility 155 00:05:57,790 --> 00:05:58,290 changes, 156 00:05:58,910 --> 00:06:03,089 most likely, that'll begin to at the 2026. 157 00:06:03,629 --> 00:06:05,790 Then on the financing, and you're asking how 158 00:06:05,790 --> 00:06:07,569 are we preparing for it financially, 159 00:06:08,485 --> 00:06:11,205 we currently have about a hundred and twenty 160 00:06:11,205 --> 00:06:12,745 days of cash on hand. 161 00:06:13,365 --> 00:06:15,944 And that doesn't sound like a lot, 162 00:06:16,485 --> 00:06:18,965 but we spend between 350 163 00:06:18,965 --> 00:06:20,745 and $400,000,000 164 00:06:21,180 --> 00:06:24,000 a month in medical care and overhead. 165 00:06:24,779 --> 00:06:28,139 Our medical care, we spend about 94ยข 166 00:06:28,139 --> 00:06:30,160 of every dollar on care. 167 00:06:30,860 --> 00:06:31,680 Our administrative 168 00:06:32,220 --> 00:06:35,199 overhead last year, we're just closing the books, 169 00:06:35,855 --> 00:06:38,384 for our last fiscal year, which ended June 170 00:06:38,384 --> 00:06:38,835 30, 171 00:06:39,215 --> 00:06:41,555 is 4.2% 172 00:06:41,615 --> 00:06:43,235 to 5.2%. 173 00:06:43,455 --> 00:06:45,855 The year will close out at 5.2 174 00:06:45,855 --> 00:06:47,074 for the full year. 175 00:06:47,569 --> 00:06:50,050 That is one of the lowest administrative overheads 176 00:06:50,050 --> 00:06:51,649 of any health plan I'm aware of in 177 00:06:51,649 --> 00:06:52,709 the state of California. 178 00:06:53,410 --> 00:06:56,629 So we're preparing by being very fiscally prudent, 179 00:06:57,089 --> 00:06:59,009 and we are preparing to make sure that 180 00:06:59,009 --> 00:07:01,810 we have adequate reserves in case there's a 181 00:07:01,810 --> 00:07:02,310 interruption 182 00:07:03,095 --> 00:07:05,254 in revenues from either the state or the 183 00:07:05,254 --> 00:07:05,754 feds. 184 00:07:06,134 --> 00:07:08,055 So those are some of the initial things 185 00:07:08,055 --> 00:07:09,435 we're looking at, Jacob. 186 00:07:10,134 --> 00:07:12,215 Absolutely. And and such an important call out 187 00:07:12,215 --> 00:07:13,814 that you made there in the beginning, Michael, 188 00:07:13,814 --> 00:07:17,100 that benefits have not been affected yet, and 189 00:07:17,180 --> 00:07:19,279 these changes will really start to become, 190 00:07:20,060 --> 00:07:22,060 more real towards the end of next year, 191 00:07:22,300 --> 00:07:24,080 and that your members need to be proactive 192 00:07:24,379 --> 00:07:27,600 with with, getting their services now before anything 193 00:07:27,740 --> 00:07:28,240 concretely 194 00:07:28,540 --> 00:07:29,040 changes. 195 00:07:30,394 --> 00:07:32,254 I'm glad you brought up the work requirements 196 00:07:32,394 --> 00:07:34,474 piece of all this because that's been, you 197 00:07:34,474 --> 00:07:36,634 know, some of the main focus, we've seen 198 00:07:36,634 --> 00:07:38,474 across the media, certainly one of the biggest 199 00:07:38,474 --> 00:07:38,974 changes, 200 00:07:39,274 --> 00:07:40,095 for Medicaid. 201 00:07:40,714 --> 00:07:41,214 So 202 00:07:41,550 --> 00:07:43,550 can you talk about how you think the 203 00:07:43,550 --> 00:07:44,050 relationship 204 00:07:44,350 --> 00:07:44,850 between, 205 00:07:45,470 --> 00:07:47,329 just in California, the Medi Cal 206 00:07:47,629 --> 00:07:50,449 with the states and then with your organization, 207 00:07:50,750 --> 00:07:51,970 a managed care organization, 208 00:07:52,350 --> 00:07:54,850 how will that influence the relationship between, 209 00:07:55,470 --> 00:07:58,714 states and and these and private insurers across 210 00:07:58,714 --> 00:07:59,375 the country? 211 00:08:00,394 --> 00:08:00,894 So 212 00:08:01,274 --> 00:08:03,915 we work very closely here in California with 213 00:08:03,915 --> 00:08:06,175 the Department of Health Care Services, 214 00:08:06,555 --> 00:08:07,055 DHCS. 215 00:08:08,800 --> 00:08:10,879 We also for those that have, 216 00:08:11,360 --> 00:08:12,500 covered California 217 00:08:12,800 --> 00:08:15,759 exchange products, we work closely with the Department 218 00:08:15,759 --> 00:08:17,860 of Managed Health Care, the DMHC. 219 00:08:19,600 --> 00:08:21,139 And then from a regulatory 220 00:08:21,840 --> 00:08:22,340 standpoint, 221 00:08:22,720 --> 00:08:23,460 our commercial 222 00:08:23,834 --> 00:08:25,134 plans here in the state, 223 00:08:25,834 --> 00:08:28,254 we have a a board called the California 224 00:08:28,475 --> 00:08:30,954 Association of Health Plans. I have the privilege 225 00:08:30,954 --> 00:08:32,495 of serving on that board, 226 00:08:32,875 --> 00:08:35,615 and it's representative of both the commercial 227 00:08:36,075 --> 00:08:37,774 as well as the 228 00:08:38,169 --> 00:08:38,990 public plans. 229 00:08:39,850 --> 00:08:40,990 And I think together, 230 00:08:41,690 --> 00:08:43,549 we try to work very collaboratively 231 00:08:44,090 --> 00:08:44,990 with DHCS 232 00:08:45,929 --> 00:08:46,750 and DMHC 233 00:08:47,690 --> 00:08:49,950 to come up with policy and implementations 234 00:08:50,410 --> 00:08:51,470 that make sense, 235 00:08:51,995 --> 00:08:52,975 but also understanding 236 00:08:53,355 --> 00:08:55,434 the state has to maintain its budget and 237 00:08:55,434 --> 00:08:57,214 has its struggles, of course. 238 00:08:57,995 --> 00:09:00,954 But we wanna be as collegial as possible. 239 00:09:00,954 --> 00:09:02,574 We wanna work on solutions 240 00:09:02,954 --> 00:09:03,454 together. 241 00:09:04,200 --> 00:09:06,360 And so to the great credit of the 242 00:09:06,360 --> 00:09:08,940 Department of Health Care Services, the director, 243 00:09:10,040 --> 00:09:11,899 of DHCS here in California 244 00:09:12,279 --> 00:09:14,700 is very amenable to meeting. 245 00:09:15,639 --> 00:09:17,340 It is a very professional 246 00:09:17,800 --> 00:09:18,300 staff. 247 00:09:19,115 --> 00:09:22,075 We look at the problems together. We offer 248 00:09:22,075 --> 00:09:22,575 suggestions, 249 00:09:22,955 --> 00:09:23,455 recommendations. 250 00:09:24,634 --> 00:09:27,434 DHCS does reach out to us and ask 251 00:09:27,434 --> 00:09:28,335 for input, 252 00:09:28,955 --> 00:09:31,720 and, we're allowed to be able to offer 253 00:09:31,779 --> 00:09:32,920 suggestions and recommendations 254 00:09:33,299 --> 00:09:34,040 on implementation. 255 00:09:35,299 --> 00:09:38,120 We know that implementing work requirements 256 00:09:38,660 --> 00:09:41,320 and implementing some of the financing changes 257 00:09:42,259 --> 00:09:44,440 is going to require a lot of collaboration, 258 00:09:44,540 --> 00:09:47,595 a lot of coordination, and a lot of 259 00:09:47,595 --> 00:09:48,095 communication. 260 00:09:49,034 --> 00:09:51,294 And so as we move forward together, 261 00:09:51,834 --> 00:09:53,534 we are going to try to 262 00:09:53,914 --> 00:09:54,654 do that 263 00:09:55,195 --> 00:09:58,334 with as little disruption and impact to services 264 00:09:58,475 --> 00:09:59,375 to our members. 265 00:09:59,834 --> 00:10:00,894 Couple of examples. 266 00:10:02,110 --> 00:10:03,809 On the financing side, 267 00:10:04,669 --> 00:10:07,549 we have to rely on actuaries. Those are 268 00:10:07,549 --> 00:10:09,649 the individuals that are skilled 269 00:10:10,190 --> 00:10:13,070 in looking at, okay, how sick is the 270 00:10:13,070 --> 00:10:13,570 population? 271 00:10:14,534 --> 00:10:16,454 And what we do is we look at 272 00:10:16,454 --> 00:10:19,274 all the claims that get filed for medical 273 00:10:19,334 --> 00:10:19,834 care. 274 00:10:20,294 --> 00:10:22,714 And each one of those claims is attached 275 00:10:22,774 --> 00:10:24,315 to a condition, 276 00:10:25,174 --> 00:10:26,475 and it gets a numerical 277 00:10:27,014 --> 00:10:27,514 number. 278 00:10:28,110 --> 00:10:30,750 And we can aggregate and pull together all 279 00:10:30,750 --> 00:10:31,570 that data 280 00:10:32,029 --> 00:10:33,250 and start to project 281 00:10:33,629 --> 00:10:36,190 how how high of a risk is this 282 00:10:36,190 --> 00:10:36,690 population, 283 00:10:37,389 --> 00:10:39,089 how what is their propensity 284 00:10:39,389 --> 00:10:41,089 for being healthy or unhealthy. 285 00:10:42,029 --> 00:10:45,245 And then the state, along with us, negotiate 286 00:10:45,384 --> 00:10:46,445 to set rates 287 00:10:47,304 --> 00:10:48,605 to be able to reimburse 288 00:10:48,985 --> 00:10:51,625 to cover the costs that are allowable under 289 00:10:51,625 --> 00:10:52,845 the Medicaid program. 290 00:10:53,465 --> 00:10:55,945 And in turn, we pass those monies on 291 00:10:55,945 --> 00:10:57,565 to the doctors and hospitals 292 00:10:58,589 --> 00:11:00,690 and providers that provide the care. 293 00:11:01,389 --> 00:11:04,269 Right now, we are relooking at, okay, if 294 00:11:04,269 --> 00:11:06,370 there's gonna be changes in enrollment 295 00:11:07,470 --> 00:11:08,529 and eligibility 296 00:11:09,149 --> 00:11:09,649 changes, 297 00:11:10,605 --> 00:11:13,424 and we have, let's say, a 20% decrease 298 00:11:13,644 --> 00:11:16,144 in the number of individuals that are eligible 299 00:11:16,365 --> 00:11:17,424 for Medi Cal, 300 00:11:17,884 --> 00:11:20,284 what does that do to the risk and 301 00:11:20,284 --> 00:11:22,625 how healthy or unhealthy is the population, 302 00:11:23,420 --> 00:11:25,180 and how much are we going to need 303 00:11:25,180 --> 00:11:26,879 in order to take care of them. 304 00:11:27,420 --> 00:11:30,779 So this is complex work. I'm trying to 305 00:11:30,779 --> 00:11:32,800 simplify it here for understanding. 306 00:11:33,580 --> 00:11:35,980 But go forward, we will have to work 307 00:11:35,980 --> 00:11:38,800 very closely with our state and federal partners 308 00:11:39,315 --> 00:11:41,575 as we take care of our almost million 309 00:11:42,434 --> 00:11:45,394 folks. In the Medicare population alone, we have 310 00:11:45,394 --> 00:11:47,254 a 127,000 311 00:11:47,394 --> 00:11:47,894 seniors, 312 00:11:48,674 --> 00:11:51,335 of which about two hundred and eighty five 313 00:11:51,475 --> 00:11:52,215 are centenarians. 314 00:11:53,154 --> 00:11:55,669 That's that's a lot of folks over 100 315 00:11:55,669 --> 00:11:57,509 years old, and I know it because I 316 00:11:57,509 --> 00:11:59,450 signed birthday cards to all of them. 317 00:11:59,909 --> 00:12:01,929 But in that, we have to understand 318 00:12:02,309 --> 00:12:03,370 how that population 319 00:12:03,830 --> 00:12:05,850 is staying or not staying healthy. 320 00:12:06,605 --> 00:12:07,585 And our largest 321 00:12:08,125 --> 00:12:10,225 growing number of individuals 322 00:12:10,925 --> 00:12:12,465 is our senior population. 323 00:12:13,085 --> 00:12:15,024 So we are gonna have to be very 324 00:12:15,085 --> 00:12:17,565 diligent as we look at the finance models 325 00:12:17,565 --> 00:12:18,305 go forward 326 00:12:18,879 --> 00:12:21,679 because the seniors, as we age, we become 327 00:12:21,679 --> 00:12:22,579 more expensive. 328 00:12:23,199 --> 00:12:25,519 So those are some of the collaborations that 329 00:12:25,519 --> 00:12:26,419 we will undertake 330 00:12:26,879 --> 00:12:30,079 with our state and federal colleagues on rate 331 00:12:30,079 --> 00:12:31,299 setting go forward. 332 00:12:32,774 --> 00:12:34,534 Absolutely. No. It's a very you're making it 333 00:12:34,534 --> 00:12:36,054 very clear. This is going to be a 334 00:12:36,054 --> 00:12:38,954 significant lift for for the Medicaid system, 335 00:12:39,495 --> 00:12:41,115 for for companies like yours. 336 00:12:41,495 --> 00:12:42,774 And it's good it's it's good to hear 337 00:12:42,774 --> 00:12:44,615 that the state is being proactive in in 338 00:12:44,615 --> 00:12:46,694 managing through some of those challenges that you 339 00:12:46,694 --> 00:12:47,194 foresee, 340 00:12:47,580 --> 00:12:49,100 Michael. And I and I I wonder if 341 00:12:49,100 --> 00:12:51,660 you would offer any advice to others listening 342 00:12:51,660 --> 00:12:54,139 in, who are also operating in the Medicaid 343 00:12:54,139 --> 00:12:56,399 states all over the country in terms of, 344 00:12:57,019 --> 00:12:59,820 how to begin navigating some of these challenges 345 00:12:59,820 --> 00:13:00,720 that you're foreseeing, 346 00:13:01,274 --> 00:13:03,834 that will pop up as as this this 347 00:13:03,834 --> 00:13:04,654 moves forward? 348 00:13:05,595 --> 00:13:07,914 So, Jacob, I think one of the key 349 00:13:07,914 --> 00:13:10,235 things, especially in our roles, you know, I 350 00:13:10,235 --> 00:13:10,735 have 351 00:13:11,274 --> 00:13:12,414 this great privilege 352 00:13:12,794 --> 00:13:14,654 to be the current CEO 353 00:13:15,200 --> 00:13:17,860 at CalOptima Health here in Orange County. I'm 354 00:13:18,159 --> 00:13:21,039 standing on the shoulders of of the other 355 00:13:21,039 --> 00:13:22,580 CEOs and the staff 356 00:13:23,120 --> 00:13:25,220 and the community that have gone 357 00:13:25,839 --> 00:13:28,339 many, many years before my time here. 358 00:13:28,674 --> 00:13:30,355 And then I will have my time and 359 00:13:30,355 --> 00:13:32,195 move on and be part of the heritage 360 00:13:32,195 --> 00:13:32,934 and legacy. 361 00:13:33,554 --> 00:13:35,475 But one of the things that we have 362 00:13:35,475 --> 00:13:35,975 proactively 363 00:13:36,355 --> 00:13:39,174 worked very hard to do is to create 364 00:13:39,315 --> 00:13:39,815 communications 365 00:13:40,514 --> 00:13:42,215 with our county partners. 366 00:13:42,980 --> 00:13:44,200 In a lot of circumstances, 367 00:13:44,899 --> 00:13:48,360 the Medicaid program that's operated by the county 368 00:13:48,419 --> 00:13:49,240 health plan 369 00:13:50,019 --> 00:13:52,039 is separate from the county, 370 00:13:52,659 --> 00:13:55,299 and we have a social service agency that 371 00:13:55,299 --> 00:13:57,000 actually does the eligibility, 372 00:13:58,455 --> 00:14:01,675 helps the individuals to fill out the applications. 373 00:14:03,095 --> 00:14:05,654 The social service agency for the county is 374 00:14:05,654 --> 00:14:08,615 the one that actually submits the application to 375 00:14:08,615 --> 00:14:09,274 the state. 376 00:14:09,894 --> 00:14:11,915 The state says yes or no, 377 00:14:12,399 --> 00:14:14,720 then sends back a file to the social 378 00:14:14,720 --> 00:14:17,279 service agency saying, here are all the eligible 379 00:14:17,279 --> 00:14:18,659 members that have been approved. 380 00:14:19,600 --> 00:14:22,799 The social service agency then sends us a 381 00:14:22,799 --> 00:14:23,299 file 382 00:14:24,095 --> 00:14:26,575 and says, please go ahead and proceed to 383 00:14:26,575 --> 00:14:29,054 put these folks on the Medi Cal role 384 00:14:29,054 --> 00:14:30,115 in Orange County. 385 00:14:30,815 --> 00:14:32,595 We issue an insurance card, 386 00:14:33,134 --> 00:14:35,215 assign them to a medical group and a 387 00:14:35,215 --> 00:14:37,554 medical home and a primary care doctor. 388 00:14:38,240 --> 00:14:40,240 What we have done the last few years 389 00:14:40,240 --> 00:14:43,139 is that we have had routine standing meetings 390 00:14:43,679 --> 00:14:46,480 with the executive leadership of the social service 391 00:14:46,480 --> 00:14:46,980 agency, 392 00:14:47,759 --> 00:14:49,860 and we work hand in hand, 393 00:14:50,654 --> 00:14:52,995 with the director and his team. 394 00:14:53,534 --> 00:14:54,674 We go to community 395 00:14:55,134 --> 00:14:56,115 events together. 396 00:14:56,654 --> 00:14:59,154 They're there with their computers and their multilingual 397 00:14:59,534 --> 00:15:03,154 staff signing people up and helping them navigate 398 00:15:03,769 --> 00:15:04,429 the application 399 00:15:05,129 --> 00:15:09,230 process to remain eligible or to achieve eligibility 400 00:15:09,450 --> 00:15:10,590 for Medi Cal. 401 00:15:11,210 --> 00:15:13,529 We go to those same community events, and 402 00:15:13,529 --> 00:15:14,830 we have our informational 403 00:15:15,290 --> 00:15:15,790 booth, 404 00:15:16,164 --> 00:15:18,105 And we actually coordinate 405 00:15:18,404 --> 00:15:19,144 our communications 406 00:15:20,164 --> 00:15:22,424 with the county social service agency 407 00:15:23,125 --> 00:15:25,445 so that the members in the community in 408 00:15:25,445 --> 00:15:29,065 all nine threshold languages that we have, English, 409 00:15:29,125 --> 00:15:30,184 Spanish, Vietnamese, 410 00:15:31,279 --> 00:15:32,500 Chinese, Korean, 411 00:15:32,800 --> 00:15:34,660 Farsi, Russian, etcetera, 412 00:15:35,360 --> 00:15:38,000 that we're both saying the exact same thing, 413 00:15:38,000 --> 00:15:40,340 that we're sending the exact same messages. 414 00:15:41,279 --> 00:15:43,860 Even the most recent letter we sent out, 415 00:15:44,375 --> 00:15:45,995 and we text our members. 416 00:15:46,615 --> 00:15:48,794 We do about 250,000 417 00:15:48,855 --> 00:15:50,554 texts a a week, 418 00:15:51,254 --> 00:15:53,575 and we told them, hey. Your privacy is 419 00:15:53,575 --> 00:15:56,615 is protected. Your benefits and eligibility have remained 420 00:15:56,615 --> 00:15:58,294 the same, and please go get your health 421 00:15:58,294 --> 00:15:58,769 care. 422 00:15:59,250 --> 00:16:01,429 We are both saying the same thing. 423 00:16:02,450 --> 00:16:05,250 I would encourage those around the country that 424 00:16:05,250 --> 00:16:07,570 listen in, and I have great regard, Jacob, 425 00:16:07,570 --> 00:16:10,149 for Becker's and their reach in health care 426 00:16:10,529 --> 00:16:13,054 and their updates that you send out on 427 00:16:13,054 --> 00:16:14,595 all sorts of disciplines, 428 00:16:15,535 --> 00:16:18,274 I would encourage them to have strong working 429 00:16:18,335 --> 00:16:18,835 relationships. 430 00:16:19,695 --> 00:16:21,315 The way it started for us, 431 00:16:21,934 --> 00:16:23,774 I picked up the phone and I called 432 00:16:23,774 --> 00:16:26,174 the director of the social service agency, and 433 00:16:26,174 --> 00:16:28,790 I said, this is who I am. I'd 434 00:16:28,790 --> 00:16:30,870 really like to start to work better with 435 00:16:30,870 --> 00:16:31,370 you. 436 00:16:31,750 --> 00:16:33,769 Let's get together and have a conversation. 437 00:16:34,310 --> 00:16:36,250 And it started with a dinner. 438 00:16:37,110 --> 00:16:39,930 And from there, we have built a standing 439 00:16:40,230 --> 00:16:40,730 relationship. 440 00:16:41,605 --> 00:16:42,504 We work collaboratively 441 00:16:43,285 --> 00:16:45,144 at community events together, 442 00:16:45,605 --> 00:16:48,565 and we're now planning and coordinating with all 443 00:16:48,565 --> 00:16:49,865 these changes because 444 00:16:50,485 --> 00:16:52,585 they field about 80,000 445 00:16:52,644 --> 00:16:56,105 phone calls a month. We field about 80,000 446 00:16:56,245 --> 00:16:56,904 a month. 447 00:16:57,659 --> 00:16:59,679 Now we're saying the same thing 448 00:17:00,139 --> 00:17:02,860 from the same talking points to ensure that 449 00:17:02,860 --> 00:17:04,720 members are getting consistent 450 00:17:05,099 --> 00:17:05,599 information. 451 00:17:06,859 --> 00:17:09,759 That to me would be a huge win 452 00:17:09,900 --> 00:17:12,400 for the community and our Medi Cal, Medicaid 453 00:17:12,460 --> 00:17:12,960 members 454 00:17:14,195 --> 00:17:16,674 that they're counting on us to get this 455 00:17:16,674 --> 00:17:17,575 stuff right. 456 00:17:18,115 --> 00:17:19,634 And I don't know that we can do 457 00:17:19,634 --> 00:17:21,654 that if we're in separate silos. 458 00:17:21,955 --> 00:17:24,134 So I would really strongly encourage, 459 00:17:24,835 --> 00:17:26,615 try to punch a hole in the silo 460 00:17:27,210 --> 00:17:29,230 and, string a phone line across 461 00:17:29,769 --> 00:17:32,269 and talk to your colleague at the county 462 00:17:32,409 --> 00:17:32,909 where, 463 00:17:33,450 --> 00:17:34,589 they do the eligibility, 464 00:17:35,289 --> 00:17:37,289 and you as the health plan provide the 465 00:17:37,289 --> 00:17:37,789 care 466 00:17:38,089 --> 00:17:40,169 communicate with each other. That would be one 467 00:17:40,169 --> 00:17:41,869 of my key messages, Jacob. 468 00:17:42,554 --> 00:17:45,194 Absolutely. Working, you know, more closely with your 469 00:17:45,194 --> 00:17:47,615 state partners and and engaging more deeply, 470 00:17:48,075 --> 00:17:49,994 with your community and with your members and 471 00:17:49,994 --> 00:17:50,494 patients, 472 00:17:50,875 --> 00:17:52,634 is is clearly going to be so key 473 00:17:52,634 --> 00:17:54,174 here over the next few years. 474 00:17:55,150 --> 00:17:57,789 Michael, throughout this entire process over these last 475 00:17:57,789 --> 00:17:59,570 several months in terms of, 476 00:18:00,029 --> 00:18:02,930 what we've been hearing from from the insurance 477 00:18:02,990 --> 00:18:05,390 community and from providers and and large hospital 478 00:18:05,390 --> 00:18:07,454 groups all over the country, There's a real, 479 00:18:07,855 --> 00:18:10,575 fear here around what is coming over over 480 00:18:10,575 --> 00:18:11,474 the next decade, 481 00:18:12,654 --> 00:18:14,974 and certainly what we've heard on the ground 482 00:18:14,974 --> 00:18:17,375 from from members and from patients all over 483 00:18:17,375 --> 00:18:18,035 the country, 484 00:18:18,575 --> 00:18:20,355 worried about losing their benefits. 485 00:18:21,359 --> 00:18:23,220 So on the flip side of of that, 486 00:18:23,440 --> 00:18:25,380 is there anything you would mention, 487 00:18:25,680 --> 00:18:27,759 in terms of specific provisions of the bill 488 00:18:27,759 --> 00:18:29,700 that you think could potentially 489 00:18:30,080 --> 00:18:33,375 reduce administrative burdens or or even just create 490 00:18:33,375 --> 00:18:35,075 new opportunities for innovation, 491 00:18:36,095 --> 00:18:37,315 in in managed care? 492 00:18:38,414 --> 00:18:40,515 So one of the things that I'm hopeful 493 00:18:40,575 --> 00:18:41,075 of 494 00:18:41,535 --> 00:18:42,275 is that 495 00:18:43,295 --> 00:18:46,674 together in our individual communities, if you've seen 496 00:18:47,480 --> 00:18:50,519 one county in The United States, you've seen 497 00:18:50,519 --> 00:18:54,059 one county. Each community is unique in itself. 498 00:18:54,920 --> 00:18:58,220 And I do have great concerns about what 499 00:18:58,359 --> 00:19:01,474 HR one and the the changes will do, 500 00:19:01,474 --> 00:19:03,494 especially to our hospital partners. 501 00:19:04,595 --> 00:19:05,335 The bill 502 00:19:05,634 --> 00:19:08,214 is to trim out 1,200,000,000,000.0 503 00:19:09,394 --> 00:19:13,174 over the next ten years into 2034. 504 00:19:14,029 --> 00:19:17,409 Of that, 665,000,000,000 505 00:19:18,349 --> 00:19:20,750 will come out of our hospitals across the 506 00:19:20,750 --> 00:19:21,250 country. 507 00:19:22,109 --> 00:19:23,569 Just here in California, 508 00:19:24,429 --> 00:19:28,289 that'll be about a $119,000,000,000 509 00:19:28,429 --> 00:19:28,929 reduced 510 00:19:29,414 --> 00:19:30,555 here in the community. 511 00:19:31,414 --> 00:19:33,414 So we are all gonna have to get 512 00:19:33,414 --> 00:19:34,475 very innovative 513 00:19:35,494 --> 00:19:37,595 about managing our overhead 514 00:19:38,134 --> 00:19:40,394 and managing the delivery of care. 515 00:19:41,174 --> 00:19:41,994 Those innovations 516 00:19:42,375 --> 00:19:44,509 will also include the implementation 517 00:19:44,890 --> 00:19:46,350 of AI technologies, 518 00:19:46,809 --> 00:19:48,190 hopefully, that will make 519 00:19:48,650 --> 00:19:51,150 processes and functions more efficient. 520 00:19:52,730 --> 00:19:54,190 Given our administrative 521 00:19:54,490 --> 00:19:55,710 overhead right now, 522 00:19:56,250 --> 00:19:57,870 at 5.2%, 523 00:19:57,930 --> 00:20:00,065 which is, like I said, the lowest that 524 00:20:00,065 --> 00:20:01,984 I'm aware of in the state with either 525 00:20:01,984 --> 00:20:03,525 a public or private plan. 526 00:20:04,305 --> 00:20:05,984 One of the things that we have done 527 00:20:05,984 --> 00:20:06,724 is starting 528 00:20:07,025 --> 00:20:07,765 to really 529 00:20:08,065 --> 00:20:08,565 medically 530 00:20:09,025 --> 00:20:10,404 manage and oversee 531 00:20:11,184 --> 00:20:13,285 our key services. So in transplants 532 00:20:13,664 --> 00:20:14,164 alone, 533 00:20:14,710 --> 00:20:15,529 we're responsible 534 00:20:15,830 --> 00:20:18,549 for about a hundred and seventy transplants a 535 00:20:18,549 --> 00:20:19,049 year, 536 00:20:19,750 --> 00:20:22,950 and we brought a specialty doctor in who 537 00:20:22,950 --> 00:20:24,490 is a transplant surgeon. 538 00:20:25,110 --> 00:20:26,730 And now he's overseeing, 539 00:20:27,670 --> 00:20:28,490 our transplant 540 00:20:28,789 --> 00:20:29,289 program, 541 00:20:30,055 --> 00:20:32,555 and he has been able to streamline 542 00:20:33,015 --> 00:20:33,515 the 543 00:20:33,974 --> 00:20:35,195 transplant process, 544 00:20:35,654 --> 00:20:37,835 streamline and eliminate a lot of 545 00:20:38,134 --> 00:20:39,515 duplicate or unnecessary 546 00:20:40,055 --> 00:20:40,555 testing, 547 00:20:41,335 --> 00:20:44,789 and make much quicker decisions to approve a 548 00:20:44,789 --> 00:20:46,170 transplant go forward 549 00:20:46,630 --> 00:20:49,910 or indicate that the patient really doesn't have 550 00:20:49,910 --> 00:20:50,570 the clinical, 551 00:20:51,269 --> 00:20:53,369 capability of accepting a transplant 552 00:20:54,404 --> 00:20:55,065 and making 553 00:20:55,605 --> 00:20:56,105 really, 554 00:20:56,644 --> 00:20:59,065 upfront good clinical decisions. 555 00:21:00,485 --> 00:21:02,565 We did it because I really felt it 556 00:21:02,565 --> 00:21:05,545 was imperative that we coordinate our care 557 00:21:05,924 --> 00:21:08,700 and that patients get timely care and not 558 00:21:08,700 --> 00:21:11,099 be waiting so long for transplants or to 559 00:21:11,099 --> 00:21:13,119 get on the list for a transplant. 560 00:21:14,380 --> 00:21:16,299 I then had a request. Well, how are 561 00:21:16,299 --> 00:21:18,460 we doing with that program? And so I 562 00:21:18,460 --> 00:21:20,240 ran some financial numbers, 563 00:21:20,794 --> 00:21:23,194 Keeping in mind, we didn't go into this 564 00:21:23,194 --> 00:21:23,694 process 565 00:21:24,075 --> 00:21:26,494 for a financial reason, but we discovered 566 00:21:27,434 --> 00:21:30,634 because we were managing the program, eliminating a 567 00:21:30,634 --> 00:21:32,815 lot of duplication and unnecessary 568 00:21:33,194 --> 00:21:36,549 repeated tests, and it's very expensive in the 569 00:21:36,549 --> 00:21:37,690 transplant world, 570 00:21:38,869 --> 00:21:41,429 we ended up reducing our year over year 571 00:21:41,429 --> 00:21:44,250 cost for transplants by $20,000,000. 572 00:21:45,429 --> 00:21:48,470 That's an efficiency that if we multiply that 573 00:21:48,470 --> 00:21:50,795 by all the health plans across the state 574 00:21:50,795 --> 00:21:51,695 doing transplants, 575 00:21:52,555 --> 00:21:54,335 what impact could we have 576 00:21:54,795 --> 00:21:55,535 on really 577 00:21:56,075 --> 00:21:59,055 not slowing down care, but speeding it up, 578 00:21:59,115 --> 00:22:00,815 but being a lot more efficient? 579 00:22:01,515 --> 00:22:03,755 Those are the types of innovations we're gonna 580 00:22:03,755 --> 00:22:05,214 have to work on together. 581 00:22:05,970 --> 00:22:07,809 And I think we have been very good 582 00:22:07,809 --> 00:22:10,529 about wanting to share our experiences. And I 583 00:22:10,529 --> 00:22:11,029 think 584 00:22:11,410 --> 00:22:13,809 if there are things that plans are doing 585 00:22:13,809 --> 00:22:15,589 today that are working well, 586 00:22:16,130 --> 00:22:18,230 it would be nice to create a toolkit 587 00:22:18,715 --> 00:22:20,795 of here's what's working well, and we're willing 588 00:22:20,795 --> 00:22:22,255 to share the white paper 589 00:22:22,875 --> 00:22:23,934 or the details. 590 00:22:24,634 --> 00:22:27,195 We are currently preparing a white paper on 591 00:22:27,195 --> 00:22:28,575 our transplant program 592 00:22:29,035 --> 00:22:30,255 to share with everybody 593 00:22:30,555 --> 00:22:31,775 how we were able 594 00:22:32,154 --> 00:22:33,455 to speed it up, 595 00:22:34,200 --> 00:22:35,419 become more efficient, 596 00:22:35,880 --> 00:22:38,380 and the byproduct was we preserved 597 00:22:38,759 --> 00:22:40,779 very precious health care dollars. 598 00:22:41,079 --> 00:22:42,919 So that's a little bit about what we 599 00:22:42,919 --> 00:22:45,339 might be able to do together to innovate. 600 00:22:46,464 --> 00:22:48,224 Sure. Sure. That's a it's a great example, 601 00:22:48,224 --> 00:22:49,585 and I I do hope some of our 602 00:22:49,585 --> 00:22:51,345 listeners take you up on that that white 603 00:22:51,345 --> 00:22:52,325 paper offer, 604 00:22:52,625 --> 00:22:53,125 Michael. 605 00:22:54,544 --> 00:22:57,585 Before we go, we we've heard from GOP 606 00:22:57,585 --> 00:23:00,065 lawmakers throughout this process and and certainly after 607 00:23:00,065 --> 00:23:02,619 the bill's passing that the focus here has 608 00:23:02,619 --> 00:23:04,160 been on improving Medicaid's 609 00:23:04,700 --> 00:23:06,400 sustainability in the long term. 610 00:23:07,180 --> 00:23:09,900 So what's your perspective on that given given 611 00:23:09,900 --> 00:23:11,660 the position you sit in? What do you 612 00:23:11,660 --> 00:23:13,740 think are some of the most important strategies 613 00:23:13,740 --> 00:23:16,944 moving forward here, in terms of preserving the 614 00:23:16,944 --> 00:23:17,845 long term viability 615 00:23:18,224 --> 00:23:19,845 of the managed care system? 616 00:23:21,024 --> 00:23:23,585 So we are a firm believer here in 617 00:23:23,585 --> 00:23:25,684 Orange County. We have had 618 00:23:26,144 --> 00:23:29,730 a long history of managed care, Medicaid, or 619 00:23:29,730 --> 00:23:31,430 what we call Medi Cal again. 620 00:23:32,130 --> 00:23:34,230 And we currently delegate 621 00:23:34,609 --> 00:23:36,470 about 700,000 622 00:23:36,769 --> 00:23:40,150 of our members to nine large delegated 623 00:23:40,450 --> 00:23:41,509 medical groups. 624 00:23:42,595 --> 00:23:45,634 I believe we are the highly the most 625 00:23:45,634 --> 00:23:46,454 highly delegated, 626 00:23:47,714 --> 00:23:50,855 health plan on the Medicaid side in California, 627 00:23:52,034 --> 00:23:54,355 and we have worked very closely with our 628 00:23:54,355 --> 00:23:56,534 managed care medical group partners. 629 00:23:57,539 --> 00:24:00,340 We have seen that a member being in 630 00:24:00,340 --> 00:24:01,400 managed care 631 00:24:01,700 --> 00:24:04,820 gets far better care than if they're fee 632 00:24:04,820 --> 00:24:05,640 for service. 633 00:24:06,500 --> 00:24:07,000 Why? 634 00:24:07,299 --> 00:24:09,779 They have a medical home, so they belong 635 00:24:09,779 --> 00:24:12,384 to a medical group and a clinic and 636 00:24:12,384 --> 00:24:13,765 a primary care doctor. 637 00:24:14,944 --> 00:24:15,444 Two, 638 00:24:15,744 --> 00:24:17,365 that managed care model 639 00:24:17,904 --> 00:24:19,605 reaches out to them consistently 640 00:24:19,904 --> 00:24:23,125 for their medical care reminders of their checkups, 641 00:24:23,664 --> 00:24:25,365 reminders of their medications, 642 00:24:26,849 --> 00:24:29,009 making sure they're following up on any of 643 00:24:29,009 --> 00:24:31,990 their disease issues or health issues, 644 00:24:32,609 --> 00:24:35,170 and that they're being managed from a case 645 00:24:35,170 --> 00:24:36,390 management standpoint 646 00:24:37,009 --> 00:24:39,890 and given access to other services that we 647 00:24:39,890 --> 00:24:41,349 as the health plan provide 648 00:24:41,674 --> 00:24:43,934 or they, as the medical group, provide. 649 00:24:44,634 --> 00:24:47,595 So we believe that being in a managed 650 00:24:47,595 --> 00:24:48,335 care model 651 00:24:48,954 --> 00:24:50,494 in a medical group 652 00:24:50,954 --> 00:24:53,755 with a medical home and a primary care 653 00:24:53,755 --> 00:24:56,174 doctor is better for your health 654 00:24:56,569 --> 00:24:58,890 than being fee for service and no one's 655 00:24:58,890 --> 00:25:01,710 really tracking or following up for you. 656 00:25:02,569 --> 00:25:04,429 I do think that it's imperative 657 00:25:05,769 --> 00:25:06,750 that the program 658 00:25:07,049 --> 00:25:09,470 continue to provide this coverage 659 00:25:10,005 --> 00:25:12,164 for those that are low income or live 660 00:25:12,164 --> 00:25:14,105 below the federal poverty level. 661 00:25:14,644 --> 00:25:15,384 We believe 662 00:25:16,005 --> 00:25:18,345 that that access to care is critical. 663 00:25:18,964 --> 00:25:21,545 But what we don't wanna have happen and 664 00:25:21,845 --> 00:25:24,825 which could really impact things severely 665 00:25:25,700 --> 00:25:26,599 is that the individuals 666 00:25:26,900 --> 00:25:27,880 lose eligibility. 667 00:25:28,900 --> 00:25:30,119 The plan changes. 668 00:25:30,660 --> 00:25:32,740 It doesn't change the fact that they need 669 00:25:32,740 --> 00:25:34,740 health care, and it doesn't change the fact 670 00:25:34,740 --> 00:25:37,000 that they will have health crisis. 671 00:25:37,700 --> 00:25:39,559 And where are they all going to go? 672 00:25:40,164 --> 00:25:42,404 In the end, what I fear is it'll 673 00:25:42,404 --> 00:25:44,184 land in the emergency room. 674 00:25:44,805 --> 00:25:47,605 I ran acute care hospitals for almost thirty 675 00:25:47,605 --> 00:25:49,944 years of my career. I've been the CEO 676 00:25:50,005 --> 00:25:51,065 of many hospitals 677 00:25:51,444 --> 00:25:53,605 and have had the great privilege of working 678 00:25:53,605 --> 00:25:55,944 with so many amazing doctors and 679 00:25:56,269 --> 00:25:56,769 communities, 680 00:25:57,710 --> 00:26:00,190 and I don't want the emergency room to 681 00:26:00,190 --> 00:26:02,210 become the primary care office 682 00:26:02,669 --> 00:26:05,470 for millions of people. Here in Orange County, 683 00:26:05,470 --> 00:26:06,450 from an eligibility 684 00:26:06,750 --> 00:26:07,250 standpoint, 685 00:26:07,869 --> 00:26:09,869 we could see up to 200,000 686 00:26:09,869 --> 00:26:11,569 of our members lose coverage. 687 00:26:12,345 --> 00:26:13,964 Where are they going to go? 688 00:26:15,144 --> 00:26:17,704 Set aside any of the other issues that 689 00:26:17,704 --> 00:26:20,184 go with the access to care and just 690 00:26:20,184 --> 00:26:22,744 focus on the care part. If you need 691 00:26:22,744 --> 00:26:26,045 emergency care under EMTALA, under federal rules, 692 00:26:27,240 --> 00:26:29,339 emergency medical treatment rules. 693 00:26:30,200 --> 00:26:33,000 Every hospital emergency room has to see you 694 00:26:33,000 --> 00:26:35,740 whether you have means to pay or not, 695 00:26:36,200 --> 00:26:38,519 but that is gonna put a huge burden 696 00:26:38,519 --> 00:26:40,700 on our hospitals. So my hope 697 00:26:41,154 --> 00:26:43,255 is that we can preserve precious 698 00:26:44,115 --> 00:26:46,755 dollars, be very efficient in our delivery of 699 00:26:46,755 --> 00:26:47,255 care, 700 00:26:47,795 --> 00:26:50,275 and still have the ability through our state 701 00:26:50,275 --> 00:26:50,775 budget 702 00:26:51,234 --> 00:26:53,335 to fund the care for individuals 703 00:26:54,000 --> 00:26:56,400 that have no ability to find care for 704 00:26:56,400 --> 00:26:56,900 themselves. 705 00:26:57,440 --> 00:27:00,240 So that's my go forward hope. And on 706 00:27:00,240 --> 00:27:00,319 a 707 00:27:01,119 --> 00:27:03,839 on another note, I also believe firmly in 708 00:27:03,839 --> 00:27:05,940 the goodness of the human heart. 709 00:27:06,414 --> 00:27:07,855 And I know that there are a lot 710 00:27:07,855 --> 00:27:09,714 of good folks out in our community 711 00:27:10,335 --> 00:27:12,835 that will figure out how to create, 712 00:27:13,775 --> 00:27:16,974 either free clinics, free access to care, free 713 00:27:16,974 --> 00:27:18,035 access to pharmaceuticals, 714 00:27:19,150 --> 00:27:21,950 free access to eye care, free access to 715 00:27:21,950 --> 00:27:22,769 dental care. 716 00:27:23,230 --> 00:27:24,289 We have amazingly, 717 00:27:25,150 --> 00:27:25,650 good 718 00:27:26,029 --> 00:27:27,250 community organization 719 00:27:27,869 --> 00:27:28,369 organizations 720 00:27:28,670 --> 00:27:29,490 and philanthropists. 721 00:27:29,789 --> 00:27:32,049 So I also wanna believe 722 00:27:32,424 --> 00:27:34,825 that many will step forward to care for 723 00:27:34,825 --> 00:27:35,644 our community. 724 00:27:36,984 --> 00:27:39,065 Wonderful. I I think that's a great last 725 00:27:39,065 --> 00:27:41,384 note to leave things on, Michael. So I 726 00:27:41,384 --> 00:27:43,704 wanna thank you for taking the time to 727 00:27:43,704 --> 00:27:45,805 sit down with us and and for sharing 728 00:27:45,945 --> 00:27:46,765 your perspective 729 00:27:47,065 --> 00:27:49,279 on what is such an important issue, 730 00:27:49,819 --> 00:27:51,339 especially in the in the years to come. 731 00:27:51,339 --> 00:27:53,119 So so thank you for taking the time. 732 00:27:53,579 --> 00:27:55,659 Jacob, thank you. And our our thanks to 733 00:27:55,659 --> 00:27:58,380 Becker's as well for hosting this. And, 734 00:27:59,179 --> 00:28:01,994 on my final final note, I really encourage 735 00:28:02,054 --> 00:28:04,775 folks out there that are responsible for these 736 00:28:04,775 --> 00:28:05,275 populations. 737 00:28:06,855 --> 00:28:09,575 Make sure that you always have that element 738 00:28:09,575 --> 00:28:10,234 of love 739 00:28:10,694 --> 00:28:13,414 that, we are really here to care for 740 00:28:13,414 --> 00:28:14,154 each other, 741 00:28:14,529 --> 00:28:17,829 And, this is really important work, and our 742 00:28:17,890 --> 00:28:18,390 community 743 00:28:19,009 --> 00:28:21,009 is truly counting on us to get it 744 00:28:21,009 --> 00:28:22,869 right. So, Jacob, thank you. 745 00:28:23,278 --> 00:28:25,198 Yeah. Thank you, Michael. And and to our 746 00:28:25,198 --> 00:28:27,038 listeners, if you'd like to listen to more 747 00:28:27,038 --> 00:28:28,958 podcasts from Becker's Health Care, you can visit 748 00:28:28,958 --> 00:28:31,218 beckershospitalreview.com.