1 00:00:02,240 --> 00:00:04,980 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:13,044 payer and health plan executives and more than 5 00:00:13,044 --> 00:00:16,504 100 speakers to Chicago April. 6 00:00:16,885 --> 00:00:19,765 This year's event includes keynote conversations with the 7 00:00:19,765 --> 00:00:23,044 industry's top leaders and former president George w 8 00:00:23,044 --> 00:00:25,605 Bush. For the full agenda and event details, 9 00:00:25,605 --> 00:00:27,809 visit beckershospitalreview.com 10 00:00:27,890 --> 00:00:29,250 and click on the events tab in the 11 00:00:29,250 --> 00:00:31,489 upper right. We're looking forward to hosting you 12 00:00:31,489 --> 00:00:32,549 here in Chicago. 13 00:00:33,969 --> 00:00:36,210 Hello, everyone. This is Jacob Emerson with the 14 00:00:36,210 --> 00:00:37,989 Becker's Payer Issues podcast. 15 00:00:38,369 --> 00:00:40,530 Thrilled today to be joined by Michael Hahn, 16 00:00:40,530 --> 00:00:43,424 who serves as the CEO of CalOptima Health, 17 00:00:43,505 --> 00:00:46,225 and YK Kim, who serves as CEO at 18 00:00:46,225 --> 00:00:46,725 CalOptima. 19 00:00:47,504 --> 00:00:49,585 Michael, YK, thank you so much for taking 20 00:00:49,585 --> 00:00:50,864 the time to be with me on the 21 00:00:50,864 --> 00:00:53,204 podcast today. Great. Thanks, Jacob. 22 00:00:54,064 --> 00:00:56,304 So, Michael, why don't you get us started 23 00:00:56,304 --> 00:00:58,144 by filling in the audience on anyone who 24 00:00:58,144 --> 00:01:00,039 might not be familiar? Can you tell us 25 00:01:00,039 --> 00:01:02,039 a little bit about your health care career 26 00:01:02,039 --> 00:01:04,040 background and then give us an overview of 27 00:01:04,040 --> 00:01:05,420 your current role at CalOptima? 28 00:01:06,439 --> 00:01:09,480 So I started my career in acute care 29 00:01:09,480 --> 00:01:09,980 hospitals. 30 00:01:10,760 --> 00:01:14,114 I actually became a CEO at age 36. 31 00:01:14,114 --> 00:01:15,555 I've been sitting in the chair a lot 32 00:01:15,555 --> 00:01:16,614 of lot of years. 33 00:01:17,075 --> 00:01:20,515 I've run psychiatric hospitals. I've run long term 34 00:01:20,515 --> 00:01:22,854 acute care hospitals. I have run, 35 00:01:23,555 --> 00:01:24,055 community 36 00:01:24,515 --> 00:01:27,094 hospitals. I have run tertiary hospitals. 37 00:01:28,069 --> 00:01:29,829 I've not had the privilege of running an 38 00:01:29,829 --> 00:01:31,370 academic medical center, 39 00:01:32,150 --> 00:01:34,630 but I've had the privilege of working in 40 00:01:34,790 --> 00:01:37,750 as CEO, 12 different hospitals in my career, 41 00:01:37,750 --> 00:01:38,490 six different, 42 00:01:39,350 --> 00:01:42,310 corporations or systems. And most recently, I ran 43 00:01:42,310 --> 00:01:44,415 the Providence Health System out here in Southern 44 00:01:44,415 --> 00:01:44,915 California. 45 00:01:45,775 --> 00:01:46,734 So I've had a very, 46 00:01:47,615 --> 00:01:50,515 interesting career on the acute care side, including 47 00:01:50,575 --> 00:01:52,515 medical groups, long term care, 48 00:01:53,215 --> 00:01:54,674 long term acute care, 49 00:01:55,399 --> 00:01:56,200 as well as, 50 00:01:56,599 --> 00:01:59,099 skilled nursing, as well as psychiatric, 51 00:01:59,719 --> 00:02:02,060 pediatric adult, and, geriatric. 52 00:02:03,000 --> 00:02:05,819 And, and now on the Medicaid acute, 53 00:02:06,280 --> 00:02:08,780 health plan side for almost ten years now. 54 00:02:09,375 --> 00:02:11,715 Wonderful. Thanks, Michael. And how about you, YK? 55 00:02:12,254 --> 00:02:14,014 Jacob, it's a pleasure to join you today. 56 00:02:14,014 --> 00:02:16,514 I'm Yoon Kyung Kim, also go by YK. 57 00:02:17,134 --> 00:02:19,634 I'm the chief operating officer of CalOptima 58 00:02:19,935 --> 00:02:20,435 Health. 59 00:02:20,814 --> 00:02:23,614 I've spent about twenty five years mostly in 60 00:02:23,614 --> 00:02:25,670 the public payer space. 61 00:02:26,129 --> 00:02:28,050 My area of interest has always been in 62 00:02:28,050 --> 00:02:30,790 the Medicaid program and then the programs 63 00:02:31,330 --> 00:02:35,189 that serve the families and communities around Medicaid, 64 00:02:35,730 --> 00:02:37,189 including Medicare duals 65 00:02:37,745 --> 00:02:39,844 and the ACA programs. 66 00:02:40,865 --> 00:02:43,344 I've had the pleasure of being able to 67 00:02:43,344 --> 00:02:45,764 see Medicaid, Medi Cal in California 68 00:02:46,544 --> 00:02:49,284 from the lens of public plans like CalOptima 69 00:02:49,504 --> 00:02:51,444 Health, as well as from, 70 00:02:52,969 --> 00:02:55,689 the publicly traded plan space and the non 71 00:02:55,689 --> 00:02:58,090 profit space. I've worked in Medi Cal up 72 00:02:58,090 --> 00:02:59,069 and down California 73 00:02:59,770 --> 00:03:01,069 in multiple counties, 74 00:03:01,689 --> 00:03:03,629 and have seen again the differences 75 00:03:04,010 --> 00:03:06,824 in how each of the local markets function 76 00:03:06,824 --> 00:03:08,905 based on size, based on the number of 77 00:03:08,905 --> 00:03:09,724 health plans, 78 00:03:10,264 --> 00:03:11,405 based on the availability 79 00:03:12,025 --> 00:03:14,125 and the partnerships with health systems. 80 00:03:14,824 --> 00:03:17,405 I've been here at CalAPNA Health now for 81 00:03:17,705 --> 00:03:20,364 a little over four years in this role 82 00:03:20,849 --> 00:03:23,409 and have the pleasure of leading our core 83 00:03:23,409 --> 00:03:23,909 operations 84 00:03:24,930 --> 00:03:28,449 coupled with our provider network, our provider systems 85 00:03:28,449 --> 00:03:29,110 and partnerships, 86 00:03:30,289 --> 00:03:33,590 closely aligned with our technology, our IT team, 87 00:03:34,129 --> 00:03:35,030 our quality. 88 00:03:35,875 --> 00:03:39,254 We've really closely aligned quality with our provider 89 00:03:39,635 --> 00:03:41,655 partnerships as well as with technology. 90 00:03:42,355 --> 00:03:44,295 And then also with our, 91 00:03:45,155 --> 00:03:48,275 business programs right now, that's Medi Cal and 92 00:03:48,275 --> 00:03:49,575 Medicaid for California. 93 00:03:50,430 --> 00:03:53,469 Medicare, we have a dual eligible special needs 94 00:03:53,469 --> 00:03:54,370 plan, OneCare, 95 00:03:54,990 --> 00:03:57,729 and our PACE program program of all inclusive 96 00:03:57,790 --> 00:03:58,930 care for the elderly. 97 00:04:00,110 --> 00:04:02,449 Wonderful. Well, YK, given your expertise 98 00:04:02,830 --> 00:04:03,729 on this topic, 99 00:04:04,064 --> 00:04:06,064 I wanna get started by talking to you 100 00:04:06,064 --> 00:04:06,965 first about 101 00:04:07,264 --> 00:04:10,084 everything coming down the pipeline with HR one. 102 00:04:10,384 --> 00:04:12,224 As I'm sure you can imagine, this has 103 00:04:12,224 --> 00:04:15,104 been a major topic for leaders in this 104 00:04:15,104 --> 00:04:17,365 industry all over the country for the last, 105 00:04:17,829 --> 00:04:19,449 almost a year now since the 106 00:04:19,990 --> 00:04:22,389 or, yeah, just about a year, this summer 107 00:04:22,389 --> 00:04:24,870 since the legislation was passed. And I know 108 00:04:24,870 --> 00:04:26,470 CalOptima has really been doing a lot of 109 00:04:26,470 --> 00:04:28,870 work to prepare for this. The company has 110 00:04:28,870 --> 00:04:30,629 committed nearly $20,000,000 111 00:04:30,629 --> 00:04:33,245 to help members navigate some of these eligibility 112 00:04:33,465 --> 00:04:36,285 changes stemming, from from the legislation. 113 00:04:36,824 --> 00:04:38,525 And, you know, we've got work requirements 114 00:04:39,145 --> 00:04:41,324 coming down the pipe, semiannual eligibility, 115 00:04:41,785 --> 00:04:42,285 redeterminations 116 00:04:42,905 --> 00:04:44,205 starting next year. 117 00:04:44,740 --> 00:04:46,279 So so how is your organization 118 00:04:46,660 --> 00:04:48,519 operationally preparing to prevent 119 00:04:48,899 --> 00:04:50,600 large scale coverage losses, 120 00:04:51,459 --> 00:04:53,319 looking into the next few years? 121 00:04:54,339 --> 00:04:55,479 That's a great question. 122 00:04:56,019 --> 00:04:58,514 You know, the changes under HR one, as 123 00:04:58,514 --> 00:05:02,134 you stated, are really around potential coverage losses. 124 00:05:02,275 --> 00:05:02,514 They're, 125 00:05:03,714 --> 00:05:06,754 they are, likely going to impact the number 126 00:05:06,754 --> 00:05:10,675 of individuals and families who remain eligible for 127 00:05:10,675 --> 00:05:12,080 Medi Cal in California. 128 00:05:13,100 --> 00:05:15,520 The thing that we've been really preparing for, 129 00:05:16,060 --> 00:05:18,540 as you alluded to, is making sure that 130 00:05:18,540 --> 00:05:20,240 our community stay informed 131 00:05:20,620 --> 00:05:22,620 on the changes. There are a lot of 132 00:05:22,620 --> 00:05:23,120 different 133 00:05:23,500 --> 00:05:24,000 eligibility 134 00:05:24,379 --> 00:05:26,160 policies that go into play 135 00:05:26,605 --> 00:05:27,745 at different times. 136 00:05:28,365 --> 00:05:31,245 Coupled with HR one for California, we also 137 00:05:31,245 --> 00:05:34,045 have changes policy changes that are stemming from 138 00:05:34,045 --> 00:05:34,865 state budget 139 00:05:35,645 --> 00:05:36,145 policy, 140 00:05:36,845 --> 00:05:38,464 decisions as well. So 141 00:05:38,764 --> 00:05:40,285 the first thing that we've been doing is 142 00:05:40,285 --> 00:05:42,305 really stressing the importance of 143 00:05:42,740 --> 00:05:46,120 factual, timely information for all of our communities. 144 00:05:46,180 --> 00:05:48,420 And that includes not only our eligible members, 145 00:05:48,420 --> 00:05:49,800 but also our providers. 146 00:05:50,420 --> 00:05:52,520 So that as a community, we are clear 147 00:05:52,580 --> 00:05:53,080 on 148 00:05:53,620 --> 00:05:55,080 what impacts we can 149 00:05:55,425 --> 00:05:58,165 expect to see and then how we can 150 00:05:58,305 --> 00:06:01,504 collectively get ahead of them. So to that 151 00:06:01,504 --> 00:06:04,625 effect, we have committed nearly $20,000,000 152 00:06:04,625 --> 00:06:05,125 to, 153 00:06:06,064 --> 00:06:07,204 outreach, navigation, 154 00:06:07,745 --> 00:06:08,245 education, 155 00:06:08,625 --> 00:06:09,925 information campaign 156 00:06:10,470 --> 00:06:12,730 to make sure that no one is losing 157 00:06:12,790 --> 00:06:13,290 coverage 158 00:06:13,990 --> 00:06:17,029 because they don't understand the changes or because 159 00:06:17,029 --> 00:06:19,430 they don't have the information to act on 160 00:06:19,430 --> 00:06:20,250 those changes. 161 00:06:20,790 --> 00:06:22,470 So that's really the first thing that we've 162 00:06:22,470 --> 00:06:25,764 done, and that's also included educating our own 163 00:06:25,764 --> 00:06:26,824 internal teams, 164 00:06:27,524 --> 00:06:29,704 so that we can provide consistent 165 00:06:30,084 --> 00:06:30,584 factual 166 00:06:31,204 --> 00:06:34,084 information to everybody who's calling us, whether they're 167 00:06:34,084 --> 00:06:36,344 calling in through the customer service line 168 00:06:36,649 --> 00:06:37,470 or if it's a provider 169 00:06:38,009 --> 00:06:40,110 calling in to ask about contract, 170 00:06:41,129 --> 00:06:42,509 or claims changes. 171 00:06:43,210 --> 00:06:44,810 So that's the first thing that we're doing. 172 00:06:44,810 --> 00:06:46,330 I think the second thing that we're doing 173 00:06:46,330 --> 00:06:48,589 is really trying to partner with our providers 174 00:06:48,730 --> 00:06:51,230 to make sure that they are well positioned, 175 00:06:52,295 --> 00:06:52,955 with information 176 00:06:53,814 --> 00:06:55,975 to help them plan their not only their 177 00:06:55,975 --> 00:06:58,615 budgets, but also their operations. So as we 178 00:06:58,615 --> 00:07:01,254 get information, as we do our projections, we 179 00:07:01,254 --> 00:07:03,035 are sharing those with our providers. 180 00:07:03,735 --> 00:07:05,175 You know, I think we've said this often. 181 00:07:05,175 --> 00:07:07,014 Michael said this often. We are nothing without 182 00:07:07,014 --> 00:07:08,970 our providers. And so as we do the 183 00:07:08,970 --> 00:07:11,370 planning, the important thing really is at the 184 00:07:11,370 --> 00:07:12,430 point of service, 185 00:07:13,129 --> 00:07:15,850 how prepared are our providers to not only 186 00:07:15,850 --> 00:07:17,790 help their patients navigate, 187 00:07:18,330 --> 00:07:20,110 but also to help their 188 00:07:21,205 --> 00:07:24,004 offices operationalize the changes and deal with potential 189 00:07:24,004 --> 00:07:26,504 patient losses, most likely patient losses. 190 00:07:27,525 --> 00:07:30,824 So helping with those types of, support activities. 191 00:07:31,444 --> 00:07:33,064 We also continue to 192 00:07:33,720 --> 00:07:34,939 promote as much 193 00:07:35,240 --> 00:07:37,980 access to health care right now as possible. 194 00:07:38,680 --> 00:07:40,920 And, again, that also includes partnering with our 195 00:07:40,920 --> 00:07:42,779 providers about how they can 196 00:07:43,319 --> 00:07:46,620 expand access. That's not just a patient 197 00:07:47,035 --> 00:07:49,694 access issue, but it's also, I think, some, 198 00:07:50,394 --> 00:07:52,634 office and business planning for our provider offices. 199 00:07:52,634 --> 00:07:54,574 How can they continue to see patients? 200 00:07:54,954 --> 00:07:56,875 How can they continue to be reimbursed for 201 00:07:56,875 --> 00:07:57,615 seeing patients? 202 00:07:57,995 --> 00:08:00,394 So we are continuing to, again, promote access 203 00:08:00,394 --> 00:08:01,375 to health care, 204 00:08:01,829 --> 00:08:03,610 regular access to health care, 205 00:08:04,149 --> 00:08:05,129 for as long 206 00:08:05,509 --> 00:08:06,089 as everyone, 207 00:08:06,709 --> 00:08:08,089 who is eligible remains, 208 00:08:08,709 --> 00:08:09,930 covered under those services. 209 00:08:10,790 --> 00:08:12,329 Understood. A lot of different, 210 00:08:12,790 --> 00:08:15,509 policy chain intricate policy changes going into effect 211 00:08:15,509 --> 00:08:17,425 across a lot of different timelines, a lot 212 00:08:17,425 --> 00:08:19,185 of communication that has to happen with your 213 00:08:19,185 --> 00:08:22,225 provider network and your members. Michael, anything you 214 00:08:22,225 --> 00:08:24,384 would add here, and and going off of 215 00:08:24,384 --> 00:08:26,865 what YK mentioned in terms of patient losses 216 00:08:26,865 --> 00:08:28,404 for for your provider network, 217 00:08:28,785 --> 00:08:31,379 can you share any projections in terms of 218 00:08:31,459 --> 00:08:33,700 how many of your members could lose coverage 219 00:08:33,700 --> 00:08:35,220 over these next few years as a result 220 00:08:35,220 --> 00:08:35,879 of this? 221 00:08:36,419 --> 00:08:39,059 So I think, clearly, if I'm sitting in 222 00:08:39,059 --> 00:08:41,379 a hospital CEO chair and I'm running an 223 00:08:41,379 --> 00:08:42,519 emergency department 224 00:08:43,220 --> 00:08:44,600 as the enrollment 225 00:08:44,899 --> 00:08:47,045 drops because there are new requirements 226 00:08:47,825 --> 00:08:50,165 and impediments to receiving care. 227 00:08:51,105 --> 00:08:52,804 That's gonna turn into uncompensated 228 00:08:53,264 --> 00:08:54,644 care or charity care, 229 00:08:55,585 --> 00:08:58,065 and with the restriction that we can't spend 230 00:08:58,065 --> 00:08:59,605 federal dollars on undocumented 231 00:08:59,985 --> 00:09:00,485 individuals. 232 00:09:01,230 --> 00:09:03,490 So, that's going to be a complicator. 233 00:09:04,350 --> 00:09:06,589 And if I'm looking at that, I wanna 234 00:09:06,589 --> 00:09:08,529 make sure I'm in front of 235 00:09:08,990 --> 00:09:11,709 the enrollment numbers as they come down. So 236 00:09:11,709 --> 00:09:14,450 what we do is I host a hospital 237 00:09:14,955 --> 00:09:16,654 CEO consortium meeting 238 00:09:17,035 --> 00:09:19,535 at our offices every quarter, and I invite 239 00:09:20,315 --> 00:09:22,555 all the CEOs from the hospitals in our 240 00:09:22,555 --> 00:09:23,055 community. 241 00:09:23,434 --> 00:09:26,014 We have 44 hospitals in Orange County. 242 00:09:26,555 --> 00:09:29,375 That includes our specialty hospital and our academic 243 00:09:29,434 --> 00:09:32,029 medical center. We don't have any public hospitals. 244 00:09:32,809 --> 00:09:35,929 So when a member loses enrollment, whether they're 245 00:09:35,929 --> 00:09:38,170 undocumented or if they're a US citizen and 246 00:09:38,170 --> 00:09:39,230 they let their enrollment, 247 00:09:40,490 --> 00:09:40,990 lapse, 248 00:09:41,290 --> 00:09:43,710 they're gonna end up potentially in the emergency 249 00:09:43,769 --> 00:09:45,629 room with a critical issue, 250 00:09:46,284 --> 00:09:47,664 and that's gonna be uncompensated 251 00:09:47,965 --> 00:09:49,664 care. So we're trying to educate 252 00:09:50,125 --> 00:09:51,424 our hospital CEOs 253 00:09:51,884 --> 00:09:54,384 around how many individuals are up for reenrollment 254 00:09:54,605 --> 00:09:55,745 in a given month. 255 00:09:56,205 --> 00:09:58,524 We are talking about what we're looking at 256 00:09:58,524 --> 00:10:00,384 in terms of discharge planning. 257 00:10:00,920 --> 00:10:03,559 We are starting to try to coordinate with 258 00:10:03,559 --> 00:10:04,860 our community clinics 259 00:10:05,399 --> 00:10:08,139 and any free clinics in the community, 260 00:10:08,759 --> 00:10:12,059 particularly around the early issues with prescriptions. 261 00:10:12,840 --> 00:10:15,720 So individuals who stopped taking blood pressure medicine, 262 00:10:15,720 --> 00:10:17,715 individuals that stop taking insulin, 263 00:10:18,575 --> 00:10:19,315 for diabetes 264 00:10:20,014 --> 00:10:21,554 and other disease states, 265 00:10:21,934 --> 00:10:24,975 that's gonna be the first hit are individuals 266 00:10:24,975 --> 00:10:26,995 that lose coverage and then can't afford 267 00:10:27,375 --> 00:10:28,274 their medication, 268 00:10:28,735 --> 00:10:30,575 rent, and food. So they're gonna have to 269 00:10:30,575 --> 00:10:31,554 give up something, 270 00:10:32,190 --> 00:10:34,269 and they're gonna keep a house hopefully over 271 00:10:34,269 --> 00:10:36,269 their head, but they may give up those 272 00:10:36,269 --> 00:10:38,850 prescriptions. So that's a real concern right now. 273 00:10:38,910 --> 00:10:41,470 So we are in active conversation with our 274 00:10:41,470 --> 00:10:43,889 hospital CEOs and community, 275 00:10:44,590 --> 00:10:46,750 hospitals to say, okay. What can we do 276 00:10:46,750 --> 00:10:47,250 to 277 00:10:47,694 --> 00:10:50,014 figure out, alright. If we don't have access 278 00:10:50,014 --> 00:10:51,714 to Medi Cal or Medicaid, 279 00:10:52,414 --> 00:10:54,414 then what? How are we gonna work in 280 00:10:54,414 --> 00:10:56,595 the community? Where are there other resources? 281 00:10:57,294 --> 00:10:59,375 And we're advising them that if we keep 282 00:10:59,375 --> 00:11:01,714 this collaborative going, keep the dialogue, 283 00:11:02,220 --> 00:11:04,639 let's coordinate with their discharge planners 284 00:11:05,419 --> 00:11:07,899 on where they can find those resources in 285 00:11:07,899 --> 00:11:10,059 the community. So those are a couple of 286 00:11:10,059 --> 00:11:12,559 more things that I think particularly for those, 287 00:11:12,940 --> 00:11:14,799 that listen to the Beckers podcast, 288 00:11:15,455 --> 00:11:17,294 I encourage you, if you haven't sat down 289 00:11:17,294 --> 00:11:20,434 with your your local plan or your Medicaid 290 00:11:20,495 --> 00:11:22,975 plan, you need to. If you haven't sat 291 00:11:22,975 --> 00:11:25,375 with the social services folks at the county 292 00:11:25,375 --> 00:11:27,715 that may do the enrollments for your state, 293 00:11:27,774 --> 00:11:29,294 then you need to sit down with those 294 00:11:29,294 --> 00:11:29,794 folks. 295 00:11:30,230 --> 00:11:33,110 And with our communications plan, as YK pointed 296 00:11:33,110 --> 00:11:35,529 out, we wanna make sure that the frequently 297 00:11:35,670 --> 00:11:36,490 asked questions 298 00:11:36,950 --> 00:11:38,970 are all answered the same way. 299 00:11:39,350 --> 00:11:40,809 So we have coordinated 300 00:11:41,269 --> 00:11:42,090 our FAQs 301 00:11:42,550 --> 00:11:44,790 with not only our call center for the 302 00:11:44,790 --> 00:11:47,254 health plan, but also with the county, 303 00:11:47,714 --> 00:11:50,595 with the hospitals, with the community clinics, with 304 00:11:50,595 --> 00:11:53,235 the federally qualified health clinics, and with our 305 00:11:53,235 --> 00:11:56,355 other community navigators so that no matter when 306 00:11:56,355 --> 00:11:58,870 the question gets asked by a Medi Cal 307 00:11:58,870 --> 00:12:00,375 or a Medicaid member, 308 00:12:00,710 --> 00:12:02,629 they get the same answer on what to 309 00:12:02,629 --> 00:12:04,549 do, how to do, and maybe where to 310 00:12:04,549 --> 00:12:05,049 go. 311 00:12:05,990 --> 00:12:07,990 Absolutely. And, Michael, I appreciate the call out 312 00:12:07,990 --> 00:12:09,990 there and the reminder for our hospital audience 313 00:12:09,990 --> 00:12:12,570 listening in about the the real risk of 314 00:12:13,544 --> 00:12:15,705 care, the rise in uncompensated care on the 315 00:12:15,705 --> 00:12:17,725 horizon and and planning around that. 316 00:12:18,825 --> 00:12:20,745 I remember when you when you joined us 317 00:12:20,745 --> 00:12:22,445 last year here on the podcast, 318 00:12:23,144 --> 00:12:25,144 a piece of this conversation, you were telling 319 00:12:25,144 --> 00:12:25,710 us about, 320 00:12:26,509 --> 00:12:30,509 CalOptima's plan to begin offering health benefits on 321 00:12:30,509 --> 00:12:33,090 the ACA marketplace on on Covered California. 322 00:12:33,710 --> 00:12:35,649 That's the exchange there for our audience. 323 00:12:36,509 --> 00:12:38,269 And that's for the 2027 324 00:12:38,269 --> 00:12:40,754 plan year. The goal to serve the roughly 325 00:12:40,754 --> 00:12:43,394 15,000 members who churn in and out of 326 00:12:43,394 --> 00:12:44,535 Medi Cal eligibility. 327 00:12:45,634 --> 00:12:47,154 But, of course, since then, as you know, 328 00:12:47,154 --> 00:12:49,174 enhanced premium tax credits have expired. 329 00:12:49,634 --> 00:12:52,695 Marketplace enrollment is down a lot nationally, 330 00:12:53,850 --> 00:12:55,690 about a million people as of the current 331 00:12:55,690 --> 00:12:58,889 data. And and premiums have, have jumped all 332 00:12:58,889 --> 00:13:02,009 over, for subsidized enrollees. It's very expensive to 333 00:13:02,009 --> 00:13:03,710 purchase care on the marketplaces. 334 00:13:04,169 --> 00:13:04,669 So 335 00:13:05,504 --> 00:13:07,184 given all of that, any updates you can 336 00:13:07,184 --> 00:13:09,264 share with us on on the company's plan 337 00:13:09,264 --> 00:13:10,225 2027 338 00:13:10,225 --> 00:13:11,285 marketplace launch? 339 00:13:11,745 --> 00:13:12,245 So, 340 00:13:13,264 --> 00:13:16,225 YK has been leading the effort for us 341 00:13:16,225 --> 00:13:17,365 at the health plan. 342 00:13:17,920 --> 00:13:19,840 We are still looking to move forward, so 343 00:13:19,840 --> 00:13:20,980 I'm gonna let YK 344 00:13:21,519 --> 00:13:24,960 kinda comment on exactly where we are as 345 00:13:24,960 --> 00:13:26,019 we look to approach, 346 00:13:26,960 --> 00:13:30,000 the exchange and go on covered California here 347 00:13:30,000 --> 00:13:30,899 in the state. 348 00:13:31,205 --> 00:13:31,705 YK? 349 00:13:32,164 --> 00:13:32,985 Thank you, Michael. 350 00:13:33,684 --> 00:13:36,085 Jacob, you're right. You're thinking the exact same 351 00:13:36,085 --> 00:13:38,164 thing that we've been thinking of in terms 352 00:13:38,164 --> 00:13:41,365 of our marketplace launch for 2027 353 00:13:41,365 --> 00:13:42,664 and how the 354 00:13:43,125 --> 00:13:45,705 environment has really shifted since we initially 355 00:13:46,404 --> 00:13:47,070 started this 356 00:13:47,629 --> 00:13:51,470 plan. We are still working towards a 2027 357 00:13:51,470 --> 00:13:51,970 launch. 358 00:13:52,590 --> 00:13:54,049 We are right now in, 359 00:13:54,669 --> 00:13:56,049 the the depths 360 00:13:56,350 --> 00:13:57,169 of applications 361 00:13:57,549 --> 00:13:58,289 and licenses 362 00:13:58,830 --> 00:14:01,629 and working with our providers on contracts, but 363 00:14:01,629 --> 00:14:02,610 all of that work, 364 00:14:03,254 --> 00:14:03,995 has maintained 365 00:14:04,934 --> 00:14:07,274 the speed and pace that we wanted to 366 00:14:07,575 --> 00:14:09,254 for a 2027 367 00:14:09,254 --> 00:14:09,754 launch. 368 00:14:10,295 --> 00:14:12,934 You're right. The environment has really changed. It's 369 00:14:12,934 --> 00:14:13,434 becoming, 370 00:14:14,215 --> 00:14:14,795 a costlier 371 00:14:15,629 --> 00:14:17,629 purchase in a market than it was a 372 00:14:17,629 --> 00:14:19,629 year ago when we were doing this. But 373 00:14:19,629 --> 00:14:22,269 I think that still speaks to the reason 374 00:14:22,269 --> 00:14:23,649 why CalOptima Health 375 00:14:24,029 --> 00:14:26,190 embarked on this. We want it to be 376 00:14:26,190 --> 00:14:28,450 a local affordable option 377 00:14:29,394 --> 00:14:31,495 FOR OUR MEMBERS AND THEIR FAMILIES. 378 00:14:32,914 --> 00:14:35,735 When their life circumstances change, and life circumstances 379 00:14:36,034 --> 00:14:37,735 are certainly changing right now, 380 00:14:38,195 --> 00:14:40,855 we think that we can still be, especially 381 00:14:40,914 --> 00:14:44,149 in this current evolving market, we can continue 382 00:14:44,289 --> 00:14:45,429 to provide 383 00:14:46,209 --> 00:14:48,929 a low cost option, an option for our 384 00:14:48,929 --> 00:14:49,669 our families 385 00:14:50,049 --> 00:14:52,549 that still provides continuity with our providers, 386 00:14:53,490 --> 00:14:56,370 a familiar health plan who has, you know, 387 00:14:56,370 --> 00:14:58,625 known their health care and known their family's 388 00:14:58,625 --> 00:15:01,184 health care. So in a way, while cost 389 00:15:01,184 --> 00:15:03,504 may be rising, it I think that speaks 390 00:15:03,504 --> 00:15:05,204 to an even more critical 391 00:15:05,745 --> 00:15:08,065 reason as to why a public plan like 392 00:15:08,065 --> 00:15:09,365 CalOptima Health 393 00:15:09,759 --> 00:15:12,579 would consider entering the market at this time. 394 00:15:13,039 --> 00:15:14,980 We've been keeping a close eye on enrollment. 395 00:15:15,600 --> 00:15:16,740 For Orange County, 396 00:15:17,519 --> 00:15:20,819 we have seen that enrollment has not significantly 397 00:15:21,360 --> 00:15:22,899 dropped as of yet. 398 00:15:23,254 --> 00:15:25,595 Of course, we're keeping close eyes on that. 399 00:15:25,654 --> 00:15:26,154 But 400 00:15:26,774 --> 00:15:28,934 regardless of, I think, the number of members 401 00:15:28,934 --> 00:15:31,335 that we may attract for those who need 402 00:15:31,335 --> 00:15:32,154 a local 403 00:15:32,534 --> 00:15:33,274 health plan, 404 00:15:34,294 --> 00:15:36,809 we wanna be there for them, whether it's 405 00:15:36,809 --> 00:15:37,930 the 15,000 406 00:15:37,930 --> 00:15:40,009 that we had expected at the beginning or 407 00:15:40,009 --> 00:15:41,870 or a smaller number than that. 408 00:15:42,730 --> 00:15:45,290 Sounds like a very fluid situation in terms 409 00:15:45,290 --> 00:15:46,649 of some of the data, but good to 410 00:15:46,649 --> 00:15:48,730 hear that our CalOptima will be there as 411 00:15:48,730 --> 00:15:50,910 an option, for families next year, 412 00:15:51,335 --> 00:15:53,014 if that is something that they do pursue 413 00:15:53,014 --> 00:15:53,915 coverage wise. 414 00:15:54,535 --> 00:15:56,934 Let's switch gears here. And and, Michael, I 415 00:15:56,934 --> 00:15:59,674 wanna talk about, your retirement, which you announced, 416 00:16:00,215 --> 00:16:01,674 just a little bit ago, 417 00:16:02,295 --> 00:16:04,134 for effective for the end of this year, 418 00:16:04,134 --> 00:16:05,274 2026. 419 00:16:05,519 --> 00:16:06,259 Congratulations, by the 420 00:16:06,639 --> 00:16:07,139 way. 421 00:16:08,000 --> 00:16:10,160 But, you know, it's been quite an interesting 422 00:16:10,160 --> 00:16:11,759 period where you've been at the helm of 423 00:16:11,759 --> 00:16:12,259 CalOptima. 424 00:16:13,040 --> 00:16:13,860 As you know, 425 00:16:14,399 --> 00:16:16,080 you started there as interim CEO back in 426 00:16:16,080 --> 00:16:17,139 2021. 427 00:16:17,360 --> 00:16:18,800 You've led the company through a lot of 428 00:16:18,800 --> 00:16:20,835 big periods for the for the health insurance 429 00:16:20,835 --> 00:16:24,035 industry in general. There's the Medicaid unwinding period 430 00:16:24,035 --> 00:16:26,215 post COVID. You launched street medicine 431 00:16:26,674 --> 00:16:27,174 programs. 432 00:16:27,955 --> 00:16:29,415 You stood up a a CalAIM 433 00:16:29,875 --> 00:16:31,475 department to meet some of the new state 434 00:16:31,475 --> 00:16:32,615 requirements with California, 435 00:16:32,995 --> 00:16:35,415 invested $50,000,000 in workforce development, 436 00:16:36,350 --> 00:16:38,769 set this this marketplace launch in motion. 437 00:16:39,309 --> 00:16:41,549 So given all of that, what are you 438 00:16:41,549 --> 00:16:42,850 most proud of of accomplishing, 439 00:16:43,309 --> 00:16:44,610 during your time at the company? 440 00:16:45,549 --> 00:16:47,009 So I made a commitment, 441 00:16:47,470 --> 00:16:49,389 to be here five years, and I'll be 442 00:16:49,389 --> 00:16:52,184 here five years as of November. 443 00:16:52,644 --> 00:16:54,404 And so I told the board that I 444 00:16:54,404 --> 00:16:56,805 think in fairness to the next CEO, they 445 00:16:56,805 --> 00:16:57,625 should start 446 00:16:57,925 --> 00:16:58,745 in January 447 00:16:59,045 --> 00:17:00,665 to assume the budget, 448 00:17:01,285 --> 00:17:02,504 for next year. 449 00:17:03,125 --> 00:17:04,769 And in this last, 450 00:17:05,250 --> 00:17:07,570 four years and the fifth year to finish 451 00:17:07,570 --> 00:17:09,509 out at the end of this year, 452 00:17:09,970 --> 00:17:11,570 I think what I'm most proud of is 453 00:17:11,570 --> 00:17:13,269 the fact that we have built trust, 454 00:17:13,809 --> 00:17:15,830 with our members and in the community. 455 00:17:16,289 --> 00:17:18,789 When we first started to host community events, 456 00:17:18,964 --> 00:17:20,404 we wouldn't have a lot of folks show 457 00:17:20,404 --> 00:17:20,904 up. 458 00:17:21,365 --> 00:17:23,684 And over this four years now, just as 459 00:17:23,684 --> 00:17:24,345 an example, 460 00:17:25,204 --> 00:17:27,625 this past year's back to school event, 461 00:17:28,244 --> 00:17:29,945 we have almost 4,000 462 00:17:30,005 --> 00:17:30,505 people. 463 00:17:31,045 --> 00:17:33,625 And, again, between kids and parents, 464 00:17:34,390 --> 00:17:37,130 it's impressive to see the individuals come. 465 00:17:37,509 --> 00:17:40,410 I look at, the sum 330 466 00:17:40,470 --> 00:17:43,269 community events that we participated in last year 467 00:17:43,269 --> 00:17:44,809 here in Orange County, California. 468 00:17:45,990 --> 00:17:47,450 And without fail, 469 00:17:48,085 --> 00:17:50,965 the magnitude of our members coming and looking 470 00:17:50,965 --> 00:17:53,945 for assistance, help, advice, guidance, navigation, 471 00:17:55,045 --> 00:17:57,205 has really been heartening. They come to the 472 00:17:57,205 --> 00:17:58,985 events, and, of course, we're coordinating 473 00:17:59,525 --> 00:18:02,085 with our clinic and community partners. So whether 474 00:18:02,085 --> 00:18:03,144 it's food resources, 475 00:18:03,869 --> 00:18:04,930 whether it's immunization 476 00:18:05,390 --> 00:18:07,490 resources, dental and eye care, 477 00:18:07,789 --> 00:18:10,269 our community partners show up. And I think 478 00:18:10,269 --> 00:18:13,390 we've built a an incredible collaborative with our 479 00:18:13,390 --> 00:18:16,349 community partners and also our schools and our 480 00:18:16,349 --> 00:18:17,234 school districts 481 00:18:17,795 --> 00:18:19,494 as well as our city governments. 482 00:18:20,035 --> 00:18:22,515 And, certainly, we've kept our state and federal 483 00:18:22,515 --> 00:18:24,134 legislators well informed, 484 00:18:24,595 --> 00:18:26,295 and we have a lot of participation 485 00:18:26,755 --> 00:18:28,535 from them at our community events. 486 00:18:28,914 --> 00:18:30,994 So what I'm proud of is the trust 487 00:18:30,994 --> 00:18:31,974 that's been built 488 00:18:32,309 --> 00:18:33,929 between us and the members, 489 00:18:34,630 --> 00:18:36,329 us and our community partners, 490 00:18:36,950 --> 00:18:39,589 us and, you know, the districts, the school 491 00:18:39,589 --> 00:18:41,450 districts, and the elected officials. 492 00:18:42,069 --> 00:18:43,210 And most importantly, 493 00:18:43,669 --> 00:18:45,109 when I look at it from the providers, 494 00:18:45,109 --> 00:18:46,250 our hospitals, our doctors, our 495 00:18:46,914 --> 00:18:48,214 doctors, our clinics, 496 00:18:48,755 --> 00:18:50,214 we're all in this together. 497 00:18:50,755 --> 00:18:53,714 And I think we come together routinely now 498 00:18:53,714 --> 00:18:54,695 to solve problems 499 00:18:55,154 --> 00:18:57,815 and figure out what can we do together 500 00:18:58,195 --> 00:18:59,174 to be successful. 501 00:18:59,634 --> 00:19:01,255 That's what I'm most proud of. 502 00:19:02,119 --> 00:19:05,880 Wonderful. Well, congratulations again, Michael. It's been, great 503 00:19:05,880 --> 00:19:07,900 getting to hear about all the things, 504 00:19:08,200 --> 00:19:10,200 that CalOptima has done over these last few 505 00:19:10,200 --> 00:19:11,980 years, here from our perspective. 506 00:19:13,000 --> 00:19:14,984 But before we go today, is there anything 507 00:19:14,984 --> 00:19:16,505 else you'd like to share with the audience? 508 00:19:16,505 --> 00:19:18,825 Any final bits of advice, while you have 509 00:19:18,825 --> 00:19:20,664 the ears of a lot of other leaders 510 00:19:20,664 --> 00:19:21,724 from across the country? 511 00:19:22,184 --> 00:19:24,984 So, again, for all the different CEOs and 512 00:19:24,984 --> 00:19:28,664 executives and aspiring executives that listen to these 513 00:19:28,664 --> 00:19:29,805 podcasts about 514 00:19:30,190 --> 00:19:32,609 how to lead in times of change. 515 00:19:33,549 --> 00:19:35,910 I have standard sayings that I use with 516 00:19:35,910 --> 00:19:38,289 the team why k knows them well. First, 517 00:19:38,349 --> 00:19:40,210 I'm not here to admire the problems. 518 00:19:40,750 --> 00:19:42,670 Let's make sure that we're dealing with the 519 00:19:42,670 --> 00:19:44,210 issues head on. Second, 520 00:19:44,894 --> 00:19:45,634 don't confuse 521 00:19:46,335 --> 00:19:47,715 activity for accomplishment. 522 00:19:48,335 --> 00:19:51,075 We can be running around thinking we're accomplishing 523 00:19:51,215 --> 00:19:52,894 something, but if you can't put a number 524 00:19:52,894 --> 00:19:53,875 up on the board 525 00:19:54,255 --> 00:19:56,414 and you can't show that you actually did 526 00:19:56,414 --> 00:19:58,434 something, in our case, for the member, 527 00:19:58,815 --> 00:20:00,549 it's not that I called them five times 528 00:20:00,549 --> 00:20:02,009 to get a doctor appointment. 529 00:20:02,309 --> 00:20:04,389 It's I called them. I got the doctor 530 00:20:04,389 --> 00:20:06,250 appointment, and they went to the doctor. 531 00:20:06,789 --> 00:20:08,569 Check mark. Now I have an accomplishment. 532 00:20:09,349 --> 00:20:10,089 And finally, 533 00:20:10,710 --> 00:20:12,789 always do your work with a purpose of 534 00:20:12,789 --> 00:20:14,984 mission. You have to love what you do. 535 00:20:14,984 --> 00:20:16,744 You have to be engaged in what you 536 00:20:16,744 --> 00:20:17,244 do, 537 00:20:17,545 --> 00:20:18,825 and you have to show up with a 538 00:20:18,825 --> 00:20:19,805 spirit of kindness. 539 00:20:20,184 --> 00:20:22,025 And I think when we do all those 540 00:20:22,025 --> 00:20:23,085 things in leadership, 541 00:20:24,345 --> 00:20:26,365 our members benefit, our organizations 542 00:20:26,825 --> 00:20:28,765 benefit, our communities benefit, 543 00:20:29,210 --> 00:20:32,029 and we as professionals and individuals benefit 544 00:20:32,410 --> 00:20:35,369 because we end up ultimately doing the right 545 00:20:35,369 --> 00:20:35,869 thing. 546 00:20:36,970 --> 00:20:39,210 YK, how about you? Any other final thoughts 547 00:20:39,210 --> 00:20:40,970 or final bits of advice you'd share with 548 00:20:40,970 --> 00:20:41,549 the audience? 549 00:20:42,025 --> 00:20:44,184 No. Thank you. You know, I think one 550 00:20:44,184 --> 00:20:46,924 of the things that really Michael alluded to 551 00:20:47,065 --> 00:20:48,765 for Orange County has been, 552 00:20:49,384 --> 00:20:52,505 our building trust with our local community and 553 00:20:52,505 --> 00:20:55,805 us sharing information, reaching out to each other, 554 00:20:56,585 --> 00:20:57,484 but not, 555 00:20:58,130 --> 00:21:00,369 looking to just protect ourselves. And I think 556 00:21:00,369 --> 00:21:02,289 that that's really what's going to help us 557 00:21:02,289 --> 00:21:04,369 get through the next few years of all 558 00:21:04,369 --> 00:21:05,269 of these changes, 559 00:21:05,809 --> 00:21:07,829 policy changes, budget changes. 560 00:21:08,609 --> 00:21:11,089 We don't do health care alone. The payers 561 00:21:11,089 --> 00:21:11,990 and the providers, 562 00:21:12,924 --> 00:21:15,005 I think it's easy for us to try 563 00:21:15,005 --> 00:21:17,904 to go into retraction mode to protect ourselves. 564 00:21:18,045 --> 00:21:19,724 We won't get through this if we do 565 00:21:19,724 --> 00:21:20,224 that. 566 00:21:20,684 --> 00:21:22,605 I think it's a real important time for 567 00:21:22,605 --> 00:21:24,285 us to be reaching out to each other, 568 00:21:24,285 --> 00:21:26,445 for payers to reach out to providers and 569 00:21:26,445 --> 00:21:27,345 vice versa, 570 00:21:27,710 --> 00:21:29,890 and figure out how we can serve our 571 00:21:30,269 --> 00:21:32,910 shared patients together. So that would be my 572 00:21:32,910 --> 00:21:34,529 final thought for today. 573 00:21:35,390 --> 00:21:37,789 Wonderful. Well, thank you both very much for 574 00:21:37,789 --> 00:21:39,789 taking the time to chat with us and 575 00:21:39,789 --> 00:21:41,549 for sharing your insights and all the latest 576 00:21:41,549 --> 00:21:42,690 that's going on at CalOptima. 577 00:21:43,054 --> 00:21:43,954 We really appreciate 578 00:21:44,575 --> 00:21:46,255 it. Thank you. Have a great rest of 579 00:21:46,255 --> 00:21:46,835 your week. 580 00:21:47,134 --> 00:21:48,414 And to our audience, if you'd like to 581 00:21:48,414 --> 00:21:50,414 listen to more podcasts from Becker's, you can 582 00:21:50,414 --> 00:21:52,835 visit beckershospitalreview.com.