This is where health insurance leadership comes together.
Becker's fourth annual spring payer issues roundtable brings
together over 400
payer and health plan executives and more than
100 speakers to Chicago April.
This year's event includes keynote conversations with the
industry's top leaders and former president George w
Bush. For the full agenda and event details,
visit beckershospitalreview.com
and click on the events tab in the
upper right. We're looking forward to hosting you
here in Chicago.
Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast.
Thrilled today to be joined by Michael Hahn,
who serves as the CEO of CalOptima Health,
and YK Kim, who serves as CEO at
CalOptima.
Michael, YK, thank you so much for taking
the time to be with me on the
podcast today. Great. Thanks, Jacob.
So, Michael, why don't you get us started
by filling in the audience on anyone who
might not be familiar? Can you tell us
a little bit about your health care career
background and then give us an overview of
your current role at CalOptima?
So I started my career in acute care
hospitals.
I actually became a CEO at age 36.
I've been sitting in the chair a lot
of lot of years.
I've run psychiatric hospitals. I've run long term
acute care hospitals. I have run,
community
hospitals. I have run tertiary hospitals.
I've not had the privilege of running an
academic medical center,
but I've had the privilege of working in
as CEO, 12 different hospitals in my career,
six different,
corporations or systems. And most recently, I ran
the Providence Health System out here in Southern
California.
So I've had a very,
interesting career on the acute care side, including
medical groups, long term care,
long term acute care,
as well as,
skilled nursing, as well as psychiatric,
pediatric adult, and, geriatric.
And, and now on the Medicaid acute,
health plan side for almost ten years now.
Wonderful. Thanks, Michael. And how about you, YK?
Jacob, it's a pleasure to join you today.
I'm Yoon Kyung Kim, also go by YK.
I'm the chief operating officer of CalOptima
Health.
I've spent about twenty five years mostly in
the public payer space.
My area of interest has always been in
the Medicaid program and then the programs
that serve the families and communities around Medicaid,
including Medicare duals
and the ACA programs.
I've had the pleasure of being able to
see Medicaid, Medi Cal in California
from the lens of public plans like CalOptima
Health, as well as from,
the publicly traded plan space and the non
profit space. I've worked in Medi Cal up
and down California
in multiple counties,
and have seen again the differences
in how each of the local markets function
based on size, based on the number of
health plans,
based on the availability
and the partnerships with health systems.
I've been here at CalAPNA Health now for
a little over four years in this role
and have the pleasure of leading our core
operations
coupled with our provider network, our provider systems
and partnerships,
closely aligned with our technology, our IT team,
our quality.
We've really closely aligned quality with our provider
partnerships as well as with technology.
And then also with our,
business programs right now, that's Medi Cal and
Medicaid for California.
Medicare, we have a dual eligible special needs
plan, OneCare,
and our PACE program program of all inclusive
care for the elderly.
Wonderful. Well, YK, given your expertise
on this topic,
I wanna get started by talking to you
first about
everything coming down the pipeline with HR one.
As I'm sure you can imagine, this has
been a major topic for leaders in this
industry all over the country for the last,
almost a year now since the
or, yeah, just about a year, this summer
since the legislation was passed. And I know
CalOptima has really been doing a lot of
work to prepare for this. The company has
committed nearly $20,000,000
to help members navigate some of these eligibility
changes stemming, from from the legislation.
And, you know, we've got work requirements
coming down the pipe, semiannual eligibility,
redeterminations
starting next year.
So so how is your organization
operationally preparing to prevent
large scale coverage losses,
looking into the next few years?
That's a great question.
You know, the changes under HR one, as
you stated, are really around potential coverage losses.
They're,
they are, likely going to impact the number
of individuals and families who remain eligible for
Medi Cal in California.
The thing that we've been really preparing for,
as you alluded to, is making sure that
our community stay informed
on the changes. There are a lot of
different
eligibility
policies that go into play
at different times.
Coupled with HR one for California, we also
have changes policy changes that are stemming from
state budget
policy,
decisions as well. So
the first thing that we've been doing is
really stressing the importance of
factual, timely information for all of our communities.
And that includes not only our eligible members,
but also our providers.
So that as a community, we are clear
on
what impacts we can
expect to see and then how we can
collectively get ahead of them. So to that
effect, we have committed nearly $20,000,000
to,
outreach, navigation,
education,
information campaign
to make sure that no one is losing
coverage
because they don't understand the changes or because
they don't have the information to act on
those changes.
So that's really the first thing that we've
done, and that's also included educating our own
internal teams,
so that we can provide consistent
factual
information to everybody who's calling us, whether they're
calling in through the customer service line
or if it's a provider
calling in to ask about contract,
or claims changes.
So that's the first thing that we're doing.
I think the second thing that we're doing
is really trying to partner with our providers
to make sure that they are well positioned,
with information
to help them plan their not only their
budgets, but also their operations. So as we
get information, as we do our projections, we
are sharing those with our providers.
You know, I think we've said this often.
Michael said this often. We are nothing without
our providers. And so as we do the
planning, the important thing really is at the
point of service,
how prepared are our providers to not only
help their patients navigate,
but also to help their
offices operationalize the changes and deal with potential
patient losses, most likely patient losses.
So helping with those types of, support activities.
We also continue to
promote as much
access to health care right now as possible.
And, again, that also includes partnering with our
providers about how they can
expand access. That's not just a patient
access issue, but it's also, I think, some,
office and business planning for our provider offices.
How can they continue to see patients?
How can they continue to be reimbursed for
seeing patients?
So we are continuing to, again, promote access
to health care,
regular access to health care,
for as long
as everyone,
who is eligible remains,
covered under those services.
Understood. A lot of different,
policy chain intricate policy changes going into effect
across a lot of different timelines, a lot
of communication that has to happen with your
provider network and your members. Michael, anything you
would add here, and and going off of
what YK mentioned in terms of patient losses
for for your provider network,
can you share any projections in terms of
how many of your members could lose coverage
over these next few years as a result
of this?
So I think, clearly, if I'm sitting in
a hospital CEO chair and I'm running an
emergency department
as the enrollment
drops because there are new requirements
and impediments to receiving care.
That's gonna turn into uncompensated
care or charity care,
and with the restriction that we can't spend
federal dollars on undocumented
individuals.
So, that's going to be a complicator.
And if I'm looking at that, I wanna
make sure I'm in front of
the enrollment numbers as they come down. So
what we do is I host a hospital
CEO consortium meeting
at our offices every quarter, and I invite
all the CEOs from the hospitals in our
community.
We have 44 hospitals in Orange County.
That includes our specialty hospital and our academic
medical center. We don't have any public hospitals.
So when a member loses enrollment, whether they're
undocumented or if they're a US citizen and
they let their enrollment,
lapse,
they're gonna end up potentially in the emergency
room with a critical issue,
and that's gonna be uncompensated
care. So we're trying to educate
our hospital CEOs
around how many individuals are up for reenrollment
in a given month.
We are talking about what we're looking at
in terms of discharge planning.
We are starting to try to coordinate with
our community clinics
and any free clinics in the community,
particularly around the early issues with prescriptions.
So individuals who stopped taking blood pressure medicine,
individuals that stop taking insulin,
for diabetes
and other disease states,
that's gonna be the first hit are individuals
that lose coverage and then can't afford
their medication,
rent, and food. So they're gonna have to
give up something,
and they're gonna keep a house hopefully over
their head, but they may give up those
prescriptions. So that's a real concern right now.
So we are in active conversation with our
hospital CEOs and community,
hospitals to say, okay. What can we do
to
figure out, alright. If we don't have access
to Medi Cal or Medicaid,
then what? How are we gonna work in
the community? Where are there other resources?
And we're advising them that if we keep
this collaborative going, keep the dialogue,
let's coordinate with their discharge planners
on where they can find those resources in
the community. So those are a couple of
more things that I think particularly for those,
that listen to the Beckers podcast,
I encourage you, if you haven't sat down
with your your local plan or your Medicaid
plan, you need to. If you haven't sat
with the social services folks at the county
that may do the enrollments for your state,
then you need to sit down with those
folks.
And with our communications plan, as YK pointed
out, we wanna make sure that the frequently
asked questions
are all answered the same way.
So we have coordinated
our FAQs
with not only our call center for the
health plan, but also with the county,
with the hospitals, with the community clinics, with
the federally qualified health clinics, and with our
other community navigators so that no matter when
the question gets asked by a Medi Cal
or a Medicaid member,
they get the same answer on what to
do, how to do, and maybe where to
go.
Absolutely. And, Michael, I appreciate the call out
there and the reminder for our hospital audience
listening in about the the real risk of
care, the rise in uncompensated care on the
horizon and and planning around that.
I remember when you when you joined us
last year here on the podcast,
a piece of this conversation, you were telling
us about,
CalOptima's plan to begin offering health benefits on
the ACA marketplace on on Covered California.
That's the exchange there for our audience.
And that's for the 2027
plan year. The goal to serve the roughly
15,000 members who churn in and out of
Medi Cal eligibility.
But, of course, since then, as you know,
enhanced premium tax credits have expired.
Marketplace enrollment is down a lot nationally,
about a million people as of the current
data. And and premiums have, have jumped all
over, for subsidized enrollees. It's very expensive to
purchase care on the marketplaces.
So
given all of that, any updates you can
share with us on on the company's plan
2027
marketplace launch?
So,
YK has been leading the effort for us
at the health plan.
We are still looking to move forward, so
I'm gonna let YK
kinda comment on exactly where we are as
we look to approach,
the exchange and go on covered California here
in the state.
YK?
Thank you, Michael.
Jacob, you're right. You're thinking the exact same
thing that we've been thinking of in terms
of our marketplace launch for 2027
and how the
environment has really shifted since we initially
started this
plan. We are still working towards a 2027
launch.
We are right now in,
the the depths
of applications
and licenses
and working with our providers on contracts, but
all of that work,
has maintained
the speed and pace that we wanted to
for a 2027
launch.
You're right. The environment has really changed. It's
becoming,
a costlier
purchase in a market than it was a
year ago when we were doing this. But
I think that still speaks to the reason
why CalOptima Health
embarked on this. We want it to be
a local affordable option
FOR OUR MEMBERS AND THEIR FAMILIES.
When their life circumstances change, and life circumstances
are certainly changing right now,
we think that we can still be, especially
in this current evolving market, we can continue
to provide
a low cost option, an option for our
our families
that still provides continuity with our providers,
a familiar health plan who has, you know,
known their health care and known their family's
health care. So in a way, while cost
may be rising, it I think that speaks
to an even more critical
reason as to why a public plan like
CalOptima Health
would consider entering the market at this time.
We've been keeping a close eye on enrollment.
For Orange County,
we have seen that enrollment has not significantly
dropped as of yet.
Of course, we're keeping close eyes on that.
But
regardless of, I think, the number of members
that we may attract for those who need
a local
health plan,
we wanna be there for them, whether it's
the 15,000
that we had expected at the beginning or
or a smaller number than that.
Sounds like a very fluid situation in terms
of some of the data, but good to
hear that our CalOptima will be there as
an option, for families next year,
if that is something that they do pursue
coverage wise.
Let's switch gears here. And and, Michael, I
wanna talk about, your retirement, which you announced,
just a little bit ago,
for effective for the end of this year,
2026.
Congratulations, by the
way.
But, you know, it's been quite an interesting
period where you've been at the helm of
CalOptima.
As you know,
you started there as interim CEO back in
2021.
You've led the company through a lot of
big periods for the for the health insurance
industry in general. There's the Medicaid unwinding period
post COVID. You launched street medicine
programs.
You stood up a a CalAIM
department to meet some of the new state
requirements with California,
invested $50,000,000 in workforce development,
set this this marketplace launch in motion.
So given all of that, what are you
most proud of of accomplishing,
during your time at the company?
So I made a commitment,
to be here five years, and I'll be
here five years as of November.
And so I told the board that I
think in fairness to the next CEO, they
should start
in January
to assume the budget,
for next year.
And in this last,
four years and the fifth year to finish
out at the end of this year,
I think what I'm most proud of is
the fact that we have built trust,
with our members and in the community.
When we first started to host community events,
we wouldn't have a lot of folks show
up.
And over this four years now, just as
an example,
this past year's back to school event,
we have almost 4,000
people.
And, again, between kids and parents,
it's impressive to see the individuals come.
I look at, the sum 330
community events that we participated in last year
here in Orange County, California.
And without fail,
the magnitude of our members coming and looking
for assistance, help, advice, guidance, navigation,
has really been heartening. They come to the
events, and, of course, we're coordinating
with our clinic and community partners. So whether
it's food resources,
whether it's immunization
resources, dental and eye care,
our community partners show up. And I think
we've built a an incredible collaborative with our
community partners and also our schools and our
school districts
as well as our city governments.
And, certainly, we've kept our state and federal
legislators well informed,
and we have a lot of participation
from them at our community events.
So what I'm proud of is the trust
that's been built
between us and the members,
us and our community partners,
us and, you know, the districts, the school
districts, and the elected officials.
And most importantly,
when I look at it from the providers,
our hospitals, our doctors, our
doctors, our clinics,
we're all in this together.
And I think we come together routinely now
to solve problems
and figure out what can we do together
to be successful.
That's what I'm most proud of.
Wonderful. Well, congratulations again, Michael. It's been, great
getting to hear about all the things,
that CalOptima has done over these last few
years, here from our perspective.
But before we go today, is there anything
else you'd like to share with the audience?
Any final bits of advice, while you have
the ears of a lot of other leaders
from across the country?
So, again, for all the different CEOs and
executives and aspiring executives that listen to these
podcasts about
how to lead in times of change.
I have standard sayings that I use with
the team why k knows them well. First,
I'm not here to admire the problems.
Let's make sure that we're dealing with the
issues head on. Second,
don't confuse
activity for accomplishment.
We can be running around thinking we're accomplishing
something, but if you can't put a number
up on the board
and you can't show that you actually did
something, in our case, for the member,
it's not that I called them five times
to get a doctor appointment.
It's I called them. I got the doctor
appointment, and they went to the doctor.
Check mark. Now I have an accomplishment.
And finally,
always do your work with a purpose of
mission. You have to love what you do.
You have to be engaged in what you
do,
and you have to show up with a
spirit of kindness.
And I think when we do all those
things in leadership,
our members benefit, our organizations
benefit, our communities benefit,
and we as professionals and individuals benefit
because we end up ultimately doing the right
thing.
YK, how about you? Any other final thoughts
or final bits of advice you'd share with
the audience?
No. Thank you. You know, I think one
of the things that really Michael alluded to
for Orange County has been,
our building trust with our local community and
us sharing information, reaching out to each other,
but not,
looking to just protect ourselves. And I think
that that's really what's going to help us
get through the next few years of all
of these changes,
policy changes, budget changes.
We don't do health care alone. The payers
and the providers,
I think it's easy for us to try
to go into retraction mode to protect ourselves.
We won't get through this if we do
that.
I think it's a real important time for
us to be reaching out to each other,
for payers to reach out to providers and
vice versa,
and figure out how we can serve our
shared patients together. So that would be my
final thought for today.
Wonderful. Well, thank you both very much for
taking the time to chat with us and
for sharing your insights and all the latest
that's going on at CalOptima.
We really appreciate
it. Thank you. Have a great rest of
your week.
And to our audience, if you'd like to
listen to more podcasts from Becker's, you can
visit beckershospitalreview.com.