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September 2022
Overview
MetroPlus Health Plan is a prepaid health plan and wholly owned subsidiary of NYC Health + Hospitals (H+H). MetroPlus contracts with H+H and other providers to provide managed health care services, such as Medicaid, Essential Plan, Child Health Plus (CHP) and Medicare Advantage plans, to eligible New York City employees and city agency day care workers, etc. It does. Private plans through NY State of Health (NYSOH, the state’s online marketplace) for more than 670,000 members. Metroplus registration changes have a direct impact on H+H’s financial stability. As more of its members choose H+H as a service provider, the hospital system will generate more revenue, a clear goal of its strategic plan. This brief updates Metroplus enrollment trends as discussed in our report: NYC Health + Hospitals Survey: Impact of Covid-19.
Pandemic impact on Metroplus health plan enrollment
Between February 2020 and June 2022, during the COVID-19 pandemic, Metroplus enrollment peaked at 670,915, an increase of 159,284 members (31 percent) (see Figure 1).
Figure 1 – Registration of Metroplus
70 percent of MetroPlus’ membership is enrolled in its original Medicaid managed care plan, which has seen the largest membership growth of any plan offered. Enrollment in the Essential Plan, a subsidized basic health plan offered through NYSOH, had the largest growth rate of all plans, at 44 percent (see Figure 2). In late January 2020, the Secretary of the US Department of Health and Human Services declared a public health emergency (PHE) for COVID-19, which would authorize Medicare and Medicaid services (a federal agency within HHS). It describes the emergency dynamics to respond to the problem. The Federal Families First Coronavirus Response Act of March 2020 allowed budget relief for states that created requirements to ensure that most beneficiaries remain continuously enrolled in Medicaid during PHE. As the New York State Department of Health (DOH) continues to enroll newly eligible individuals, people are allowed to enroll in Medicaid, CHP, and essential plans without annual renewal. This provision means that enrollments in these schemes will continue to increase through PHE, which is currently approved, until mid-October 2022.
Figure 2 – Metroplus registration by plan type
MetroPlus also increased market share in Medicaid managed care and essential plan enrollment in the city. MetroPlus’s citywide enrollment share of major Medicaid managed care plans, which cover the largest share of its members, grew from 14.8 percent in February 2020 to 15.8 percent in June 2022, the highest since 2014 (based on data through February) and the third largest plan in the city. Enrollment in these plans increased by 34 percent, while enrollment in other Medicaid managed care plans offered in the city increased by 24 percent. Metro Plus’ citywide subscription share has grown from 17 percent to 19 percent during the same period.
Metroplus Financial and Operational Impact on NYC Health + Hospitals
H+H’s financial stability is impacted by Metroplus’ ability to attract new members and retain existing members and focus on better care management. To maximize revenue from Metroplus, H+H is working together to attract more members to use H+H health services and engage members in regular chronic care management to avoid unnecessary high costs. In addition, Metroplus has taken steps to ensure that members have access to comprehensive care management, including services that meet medical, social and behavioral health needs, to meet the needs of H+H frequent hospital use. For example, in 2017 Metroplus and H+H established a housing task force to connect H+H patients in need of affordable and supportive housing, including those who are members of Metroplus. As a result, more than 300 members of Metroplus were placed. Increasing primary care and specialty care services for insured patients at H+H health care facilities directly supports H+H’s strategic plan toward fiscal stability.
Despite the efforts of MetroPlus and H+H, the majority of MetroPlus members use health care providers other than H+H. The cost share of Metroplus in H+H institutions has decreased from 40 percent in fiscal year 2019 to 39.1 percent in 2021 and 39.1 percent in 2021. (see Figure 3).
Figure 3 – Metroplus Medical Cost by H+H share
As part of its outreach efforts to find new members, MetroPlus refers individuals who are ineligible or uninsured to the NYC Care program, a financial assistance program that provides a wide range of health care services at H+H facilities on a sliding scale. Payment.
As part of DOH’s efforts on statewide Medicaid payment reform, H+H and MetroPlus have entered into an agreement that encourages reimbursements based on quality and cost-effectiveness from a volume-based reimbursement model. This value-based payment (VBP) arrangement requires H+H to assume medical risk for all covered services for eligible patients in the VBP arrangement, even if that care is provided outside of the H+H system. Metroplus will pay all medical expenses associated with the VBP arrangement and make payment to H+H after finalizing the remaining net amount. Risk sharing paid is $199 million and $428 million in 2021 and 2020, respectively.
In the year In 2020, during the first wave of the Covid-19 pandemic, MetroPlus ranked highest among the state’s 15 Medicaid managed care plans in the DOH’s Quality Incentive Program, which evaluates performance across a wide range of quality measures.
Federal public health emergency wind
When the PHE expires, the continuous subscription offer and other subscription efficiencies provided during the PHE will end. According to federal guidelines, the DOH must return to normal eligibility and enrollment operations and complete all renewals within 14 months. As PHE sunsets, the state provides tools to help stakeholders inform enrollees about renewing coverage. Metroplus has developed education and membership delivery strategies to sustain enrollment growth achieved during the pandemic. As the member renewal process returns to normal, enrollment in these plans may decrease and some members may not renew or become eligible for coverage. However, the state’s fiscal year 2023 enacted budget includes provisions that expand eligibility in public health plans offered through MetroPlus.
If MetroPlus succeeds in adding new eligible members to its plans, it may offset potential losses in enrollment. Metroplus enrollment is at an unprecedented level, but this will be a challenge to maintain as PHE winds down. Metroplus is working with H+H to facilitate faster enrollment in Medicaid for those still eligible and transition those who lose eligibility to essential plan coverage. MetroPlus is engaging city and state partners to continue easing these transitions by leveraging public benefits information and eligibility options still available from the federal government to protect members’ coverage and prevent care gaps. Continued collaboration with New York State is critical to assisting this effort.
Additionally, to continue to attract Metroplus members, H+H must continue to provide quality care and efforts to improve patient satisfaction. These efforts will enable H+H to achieve its goal of achieving 45 percent of Metroplus’ medical spending and help it successfully execute on its strategic plan.
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