Inland Empire Challenge of Health Care Reform

Presenter Bradley P. Gilbert, M.D., M.P.P.

Chief Executive Officer

Who is IEHP • IEHP is a Local Initiative • We are a Public Entity, formed as a Joint

Powers Agency (JPA), created by Riverside and San Bernardino Counties

• IEHP: – Is organized as a Public Agency, Non-Profit HMO – Became operational on September 1, 1996 – Is a mixed model HMO as follows:

• #1 Contract with Independent Physician Associations (IPAs)

• #2 Direct Physician Contracting

Total Population Enrolled Into IEHP By Program

Total IEHP Program Members* Medi –Cal 489,675 Healthy Families 55,634 Healthy Kids 4,074 Medicare (SNP) 7,518 556,901 *May 1, 2012

Unemployment Rate Comparison - December 2007 - March 2012

4.0%

8.0%

12.0%

16.0%

Dec-07 Dec-08 Dec-09 Dec-10 Dec-11 Mar-12

Inland Empire

California

United States

From the Bureau of Labor Statistics website http://data.bls.gov/

Medi-Cal Eligibles in the Inland Empire 2007 - 2011

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Dec-07 Dec-08 Dec-09 Dec-10 Dec-11 From the DHCS Pivot Tables http://www.dhcs.ca.gov

The Uninsured in the Inland Empire - 2007 - 2011

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Dec-07 Dec-08 Dec-09 Dec-10 Dec-11

Data not yet available.

Data from the Insure The Uninsured Project http://www.itup.org

State Policy Changes

• California trend is to enroll most, if not all, Medi-Cal Members in Managed Care Plans

• Seniors and Persons with Disabilities – Mandatorily enrolled June 2011 – May 2012

• Community Based Adult Services (CBAS – formerly ADHC) benefit only available through Managed Care starting October 2012 (COHS Counties July 2012)

• Duals Demonstration – four counties (Los Angeles, San Mateo, Orange and San Diego) now, trying to expand to eight – Mandatory enrollment for Medi-Cal, including LTC

and LTSS – Passive enrollment for Medicare

Physician Supply

• Primary Care Physicians – CA = 63/100,000 – Riverside = 36/100,000 – San Bernardino = 44/100,000

• Specialists – CA = 115/100,000 – Riverside = 62/100,000 – San Bernardino = 77/100,000

Healthcare Reform Inland Empire

0

500,000

1,000,000

1,500,000

2,000,000

Employer Coverage

Individual Coverage

Medi-Cal Healthy Families Uninsured

Popu

latio

n

Type of Coverage

Pre-Reform

Post-Reform

Uninsured

0

200,000

400,000

600,000

800,000

1,000,000

Inland Empire Riverside San Bernardino

Popu

latio

n

Region

Pre-Reform

Post-Reform

Individual Coverage

0

100,000

200,000

300,000

400,000

500,000

Inland Empire Riverside San Bernardino

Popu

latio

n

Region

Pre-Reform Post-Reform

Medi-Cal

0

200,000

400,000

600,000

800,000

1,000,000

Inland Empire Riverside San Bernardino

Popu

latio

n

Region

Pre-Reform Post-Reform

Forecasted IEHP Medi-Cal Membership for FYs 2011 to 2015

300,000

450,000

600,000

750,000

Jul-11 Jan-12 Jul-12 Jan-13 Jul-13 Jan-14 Jul-14 Jan-15

Medi-Cal Mandatory Medi-Cal Voluntary

MC Expansion begins

Assumptions: • 13% growth rate for FY 11/12 • 5% growth rate for FY 12/13 • Medi-Cal Expansion*: ° Annual: 206,000 Members ° Monthly: 17,000 Members *Based on Milliman Report, 2011

13% growth 5% growth

738,803

Forecasted Total IEHP Membership by Line of Business FYs 2010 to 2015

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Jan-10 Jan-11 Jan-12 Jan-13 Jan-14 Jan-15

Health Exchange

Medicare DualChoice

Healthy Kids

Healthy Families

Medi-Cal

MC Expansion & Health Exchange

begin

HK funding from F5 and RCHF only

Mandatory SPD Enrollment

begins June 2011

879,813

Challenges Going Forward

• Inadequate PCP supply now • Inadequate specialty physician supply

now with significant geographic disparities

• Large increase in insured individuals – Medi-Cal – low rates, difficulty attracting

providers – Exchange – in theory commercial rates, ?

crowding out Medi-Cal patients • Inpatient bed shortage in certain regions –

some construction planned

Ideas

• Increase physician capacity – Work with entities that employ physicians

– FQHCs, larger physician groups – Consider grants to “jump start” hiring

(FQHC grant program) – Use ‘ed payments to PCPs through

Medi-Cal (Medicare rates) strategically to recruit new physicians or groups

– Work with groups/entities that have not traditionally done Medi-Cal

Final Thought

• Await Supreme Court Decision – Individual mandate and Exchange – Medicaid expansion – One without the other

• Hope economic recovery persists and improves

• UC Riverside Medical School – And Residency Programs