Politi­cians’ ACA stance de­pends on how close they are to the point of ser­vice

Modern Healthcare - - Q&A -

Since July 2014, Ge­orge Masi has served as pres­i­dent and CEO of Har­ris Health Sys­tem, a $1.4 bil­lion pub­licly owned safety net sys­tem based in Hous­ton serv­ing Har­ris County, Texas, with three hos­pi­tals and 47 sites. It also has an af­fil­i­ated Med­i­caid health plan called Com­mu­nity Health Choice with more than 300,000 mem­bers. It was re­cently re­ported that Texas Gov. Greg Ab­bott got miffed at the lead­ers of Har­ris Health and its health plan be­cause the plan’s CEO was pub­licly push­ing for Med­i­caid ex­pan­sion while the state was ne­go­ti­at­ing with the Obama ad­min­is­tra­tion for re­newal of its big Med­i­caid waiver. Masi pre­vi­ously served as the sys­tem’s ex­ec­u­tive vice pres­i­dent and chief op­er­at­ing of­fi­cer. Be­fore that, he served as a ca­reer of­fi­cer with the Army Med­i­cal Depart­ment, head­ing Winn Army Hos­pi­tal at Fort Ste­wart, Ga. Mod­ern Health­care re­porter Vir­gil Dick­son re­cently spoke with Masi about the pol­i­tics of Med­i­caid ex­pan­sion, his sys­tem’s re­cent tight­en­ing of its char­ity-care pol­icy, and the prospects for re­newal of the Med­i­caid waiver. This is an edited tran­script.

“I have not seen much trac­tion at all at the state level to ex­pand Med­i­caid.”

Mod­ern Health­care: How is open en­roll­ment un­der the Af­ford­able Care Act go­ing?

Ge­orge Masi: It’s very early. At Har­ris Health, we have sev­eral hun­dred trained fa­cil­i­ta­tors in place at our el­i­gi­bil­ity cen­ters, clin­ics and hos­pi­tals to fa­cil­i­tate this process for pa­tients who are in­ter­ested in mov­ing to the ex­changes. So we’re op­ti­mistic.

MH: Are you see­ing a soft­en­ing from state lead­ers to­ward the Af­ford­able Care Act, or is there still a lot of op­po­si­tion?

Masi: When you get close to the point of ser­vice, the

mu­nic­i­pal­ity or the neigh­bor­hood, ir­re­spec­tive of po­lit­i­cal af­fil­i­a­tion, the case is so com­pelling to take ad­van­tage of the law in terms of in­creas­ing health­care ac­cess and re­duc­ing the lo­cal tax bur­den that you see in­creas­ing trac­tion lo­cally. At the state level, when you get fur­ther re­moved from the re­al­i­ties of day-to-day ac­cess to care, it be­comes much more ab­stract and ide­o­log­i­cal. I have not seen much trac­tion at all at the state level to ex­pand Med­i­caid.

MH: What are you see­ing in terms of the trend of unin­sured peo­ple com­ing into your fa­cil­i­ties?

Masi: Here in Har­ris County, we have the largest num­ber of unin­sured of any ma­jor met­ro­pol­i­tan county in the coun­try. Of about 4.7 mil­lion res­i­dents, up­wards of 900,000 in­di­vid­u­als are still with­out in­sur­ance. A large por­tion is the co­hort that would be el­i­gi­ble for Med­i­caid ex­pan­sion who do not have ac­cess to that pro­gram (be­cause Texas has not ex­panded Med­i­caid).

Pa­tients who have not had ac­cess to in­sur­ance are be­com­ing ever more knowl­edge­able about their in­sur­ance op­tions. This is through a lot of ed­u­ca­tion and nav­i­gat­ing. Slowly but surely, we’re see­ing greater trac­tion.

MH: What is Har­ris Health’s pol­icy on pro­vid­ing char­ity care to peo­ple who are el­i­gi­ble for sub­si­dized ex­change cov­er­age but have not en­rolled?

Masi: We’ve made some dra­matic changes in the last sev­eral months. We worked with our board to change the fed­eral poverty level ac­cess point for char­i­ta­ble care, from 200% of poverty to 150%. Above 150% of poverty, you’re con­sid­ered a self-pay pa­tient. You can still be seen at Har­ris Health, but you would have to make pay­ment for the care that you re­ceive.

Nine­teen thou­sand of our pa­tients no longer qual­ify un­der those cri­te­ria, out of 325,000 pa­tients we serve on a rou­tine ba­sis. For those who are el­i­gi­ble for the ex­changes, we of­fer as­sis­tance to fa­cil­i­tate that en­roll­ment process for them.

MH: Why was that change made?

Masi: First, ev­ery­one on the board is very sup­port­ive of the Af­ford­able Care Act. It was clear that by main­tain­ing the char­i­ty­care pol­icy at 200% of poverty, we were subverting the in­tent of the Af­ford­able Care Act, which was to make in­sur­ance avail­able for those who would qual­ify.

Sec­ond, by mov­ing 19,000 pa­tients from char­ity care into in­sur­ance, my health sys­tem ben­e­fits from hav­ing pa­tients who are in­sured. The rev­enue is very im­por­tant to us. At

Har­ris Health, 60% of our pa­tients have been des­ig­nated as char­ity-care pa­tients, 9% Medi­care, 22% Med­i­caid, and 5% com­mer­cial.

That payer mix is un­sus­tain­able. By mov­ing pa­tients into an in­sur­ance pro­gram, we cal­cu­lated that for the com­ing year, we would gain about $20 mil­lion in ad­di­tional rev­enue that we could put into ex­pand­ing ser­vices.

MH: What has been the im­pact of un­doc­u­mented in­di­vid­u­als on your sys­tem, since that’s a large pop­u­la­tion in Texas?

Masi: It’s been sig­nif­i­cant. About 20% of our pa­tients are un­doc­u­mented. Out of our an­nual bud­get of $1.4 bil­lion, about $200 mil­lion of that, as best we can track it, are dol­lars al­lo­cated to care that we pro­vide to in­di­vid­u­als who are not el­i­gi­ble for health in­sur­ance. Most of that is the un­doc­u­mented.

MH: Are un­doc­u­mented peo­ple with an in­come over 150% of poverty still el­i­gi­ble for char­ity care, since they can’t buy cov­er­age on the ex­change?

Masi: Our board in­sti­tuted a pro­gram that we term My Har­ris Health. It’s for pa­tients be­tween 150% and 200% of poverty who don’t have ac­cess to the ex­change. They can sign up for our pro­gram and are re­quired to make means-based fi­nan­cial con­tri­bu­tions to their health­care bill.

Those pay­ments are sim­i­lar to what a pa­tient would pay for an ex­change plan. We did that to main­tain sym­me­try be­tween those who are el­i­gi­ble for the ex­change and those who are not.

MH: If an un­doc­u­mented per­son de­cides not to par­tic­i­pate in this pro­gram, what hap­pens?

Masi: If you de­cide not to sign up for ei­ther the ex­change or My Har­ris Health, you’re cat­e­go­rized as a self-pay pa­tient. You will not be able to get a rou­tine ap­point­ment.

Of course, ev­ery­body has ac­cess to the emer­gency cen­ter, as al­ways. But as a self-pay pa­tient, you will not have ac­cess to rou­tine care.

MH: What im­pact has Texas’ fed­eral De­liv­ery Sys­tem Re­form In­cen­tive Pay­ment Pro­gram waiver had on Har­ris Health?

Masi: The five-year DSRIP waiver is ba­si­cally to ex­pand ac­cess to pri­mary care and be­hav­ioral health, and to de­com­press emer­gency rooms.

The fed­eral gov­ern­ment pro­vided sub­stan­tial re­sources for or­ga­ni­za­tions to take ad­van­tage of that op­por­tu­nity. At Har­ris Health, we did that in dra­matic fash­ion.

We’ve opened seven new clin­ics, gen­er­at­ing 150,000 new pa­tient ap­point­ments. We’ve also em­bed­ded be­hav­ioral health ser­vices in all of our out­pa­tient clin­ics, gen­er­at­ing mul­ti­ple thou­sands of vis­its for be­hav­ioral health is­sues.

If the waiver is not re­newed or ex­tended, the im­pact would be pro­found for us and for this com­mu­nity, be­cause we’ve ex­panded ser­vices and in­creased ac­cess to care, which is won­der­ful.

We’re cau­tiously op­ti­mistic the waiver will be ex­tended.

Whether it would be re­newed for the full five years, that’s more prob­lem­atic be­cause of the po­lit­i­cal dy­namic of tension be­tween Texas and HHS (over the state’s re­fusal to ex­pand Med­i­caid).

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.