um and now this panel uh uh uh uh we'' ll. we ' re gon na have some a very uh important point of view from a series of medical care.
payers in texas um we know that you know foundations like like ours as well as others.
can not cover continuous costs of social care so generally you know we try to look at our.
medical care payers to aid develop sustainability with this panel what we really hope to do is that you.
recognize we'' ll have the chance to understand some of the issues and also complexities related to paying.
for social needs targeted care each panelists will certainly share a bit concerning their job that they are.
doing as well as the course forward for them they will additionally be speaking about concerns and.
challenges you understand points like the pool as well as the push elements um such as you understand the requirement to.
show a return on financial investment roi uh in a specific timespan so that you recognize they are able to make.
a company instance for supporting this kind of job you recognize our value proposition before i present.
the panelists a quick suggestion on how the panels are will work everyone other than panelists as well as.
myself ought to have their video off currently each panelist will certainly have concerning eight minutes.
to speak there will certainly not be any kind of slides besides four share their ready statements i''
ll. take questions from the audience if you would certainly such as to ask an inquiry please elevate your hand uh.
similar to the session earlier to increase your hand over the individuals panel by clicking on.
participants under of your zoom screen click your name and also you'' ll see a sign to. raise your hand at any moment throughout the conference you can submit the info remarks or questions.
via the chat box to the conference holes if you have any kind of technical troubles please send out.
a conversation and somebody will certainly try to help you out currently it is my honor and privilege to.
introduce to you the 4 panelists again you know we are keeping the intro.
uh really short so that we have lots of time for conversation however understand that you know uh uh.
it'' s simply you know such an excellent honor to have each one of them to join us this afternoon uh.
to start with uh we have uh dr ryan wen ramshaw uh the primary medical policeman.
for texas medicaid at hsc we additionally have uh jamie duden singh the ceo.
for the texas association of health insurance plan and also followed by katrina daniel the chief healthcare.
officer of teachers retirement system of texas last yet not least uh we have a teresa skibanski.
primary administrative officer of university health systems she'' s additionally the acting president as well as principal.
executive officer of area initial health insurance plan keeping that said allow me pass.
the mic over to uh dr wee many thanks dr sim for the intro once again good.
afternoon everyone my name is ryan benramshorst dr v for brief i'' m the primary medical director for.
medicaid chip services and i'' ve been in this duty for simply over 16 months i'' m really enjoyed be.
joining this discussion this afternoon with the various other panelists as well as the.
individuals that are in the virtual audience i'' ve had the pleasure of functioning or engaging.
with most of you as well as most definitely enjoyed the very first panels conversation and also i understand that this is gon na.
proceed um you recognize considering this really crucial problem of social determinants of health and wellness.
and also incorporating that with the health and wellness treatment system um i involve this largely from the perspective as.
a general neighborhood pediatrician uh like dr smith you recognize the first two years of my method.
i remained in the nationwide health and wellness solution corps as well as i got on the south side of san antonio.
i was the only doctor for a while at a relatively big center clinic in a really.
underserved area and also i believe much of the issues that we'' ve we ' ve currently spoken about.
this mid-day i i saw each day i bear in mind one of the the initial type of conferences i had with.
my medical supervisor was around you know was i on point with meeting certain top quality metrics um.
which absolutely element right into this discussion and one of those metrics was the percentage of.
my person panel that was overweight or overweight as well as i bear in mind just believing to myself wow how.
just how as well as what can i do to address that very complicated multi-factorial problem with my clients when i only.
have 15 mins in the space with them and and you know believing through what sources might i.
take advantage of where was the closest ymca where was the closest food bank did we have a social employee.
that could help we consult with the households with the nutritional expert as well as and really learned early the.
value of knowing those community sources and i believe to um you know keegan'' s. remarks previously i did have the pleasure of training in a residency program that did have.
a clinical lawful partnership um and absolutely discovered a bunch from the value that that brought.
uh to my people into our community and also so um that'' s sort of the the means that i approach this
. job is i'' m a pediatrician when it comes down to it so um texas medicaid um as you may be mindful.
um is a public insurance coverage program that in texas covers in between 4 to four as well as a fifty percent million.
lives um about 3 million three million and also of those lives are kids we also cover grownups.
with impairments we cover expectant females and a couple of other sub groups of individuals via our.
waiver programs and it'' s important context to recognize that in texas medicaid is greatly handled care.
and also i recognize ms dude saying who'' s going to talk quickly after me is mosting likely to discuss lots.
of manner ins which our handled treatment companies or mcos are working to do great points in the space.
of social determinants of wellness and also of those four to 4 and a half million people that.
are covered through texas medicaid or chip for that matter 95 plus percent of those.
individuals remain in a managed treatment program so we have 18 various took care of care companies to.
soon to be 3 dental upkeep companies and afterwards we have a smaller sized portion of individuals that.
remain in fee for solution so i believe it'' s crucial context particularly for this panel that'' s kind. of how texas has actually chosen really over the previous 20 plus years to progress our medicaid program.
to be a managed treatment medicaid program which is comparable to to lots of various other bigger states and.
some smaller states for that issue yet we have a lot more mcos than your average state does so.
reasoning of social components of wellness i assume there'' s a pair points that i intended to highlight.
in my remarks below um as well as one involves the job of something called disrep which represents.
delivery system reform reward settlement program which belongs of what'' s called a medicaid. 1115 waiver that texas was able to obtain to draw down additional bucks to take.
treatment of people on medicaid in addition to the low-income uninsured and so through that the.
texas wellness as well as human solutions commissioner hhsc has actually partnered with carriers from across the.
state to provide medicaid solutions and also added services to individuals that possibly don'' t get.
medicaid as well as social determinants of health does contribute in our area program what you may.
have heard is that the state remains in the process of transitioning away from interfere with and as part.
of that job we have to create a change plan which we send to our government partners at.
the facility for medicare medicaid solutions cms which strategy which you can discover on our.
web site and also we can see to it is shared with you has a variety of turning points that hhsc is held.
responsible for and also among those turning points is especially around social components.
of wellness which landmark asks for a research of kinds looking especially at the.
texas medicaid population looking at health outcomes and checking out those social elements.
that have something to do with those results and really for me as much as i'' m mindful this is the.
initially texas medicaid specific social determinants of health and wellness study that that we'' re aiming to do and.
this remains in collaboration with the eqaro which is our outside high quality testimonial company which is the.
institute for kid wellness plan in florida which has dealt with the college of texas institution.
of public health to check out this to do this study and while i pointed out that most of texas medicaid.
enrollees are children we'' re taking a look at youngsters we ' re looking at expecting ladies yet we'' re additionally. mosting likely to check out social factors of health for our grown-up populaces also so i'' m truly. actually thrilled to be the executive enroller of that turning point as well as i'' d like to recognize two. of the wonderful colleagues i reach work with who are accountable of the turning point with me joelle june and.
lauren calfel who are also on the phone call therefore simply a large yell out to them for every one of their effort.
to ensure that'' s one part of area um as you might visualize there'' s lots of various other landmarks there ' s core. tasks there ' s various other data that we'' re tracking and via that job we also have something.
called the most effective practices function team where we have checked service providers that are working in interrupt.
to get their thoughts on a selection of points we recently did a study march as well as.
april of this year so not long ago utilizing a changed deltie approach to look at.
at various you understand turning points that individuals are collaborating with as well as social determinants of health.
came up a great deal as you might envision we get comments on the significance of area wellness.
workers we listened to just how food instability screening appears like an excellent area to begin when it.
pertains to social components of health and wellness as well as we listened to other points like information sharing.
as well as the value of that we additionally received some responses on alternate payment models and.
value-based acquiring value-based settlement as well as we know moving forward our managed care organizations.
our mcos are wanting to work together with service providers in these new settlement models where it'' s. tipping far from a much deeper solution technique as well as moving towards results based settlement that may.
extremely well consist of social determinants of wellness and we know that a lot of our mcos with the.
work that they'' ve currently been doing as well as resolve an understanding collective which. i understand the pupils is mosting likely to touch upon which has greatly been supported by dr sim ms.
marx with the episcopal health structure center for healthcare approaches is currently going on.
as well as so those are simply a few of the important things um that i wished to discuss um and um you understand i i.
did also desire to state that you understand i'' ve had the satisfaction of working with dr smith before and.
she pointed out that she had actually sent um a subject election to include food insecurity testing.
to our texas healthstep wellchild program once more our texas aid step program is how we.
operationalize a medicaid benefit called epsdt very early periodic diagnostic testing and also.
treatment which is our well test program and that topic election process of course is.
available to any kind of stakeholder that desires to add to our medicaid program and also so we'' ve gotten.
her election to add hunger as an essential indicator to our program which possibly might include.
repayment which is an additional style that we have heard continuously from service providers and mcos is that.
if we really wish to support moving ahead with social factors of health as well as medicaid we additionally.
need to have a conversation on exactly how we'' re going to cover that in terms of price as well as just how it'' s going to. be paid therefore type of returning to one of the inquiries that dr sim and dr nimmy asked the panel.
is you understand what type of end results are you looking for so so as the medicaid firm you understand it is.
extremely vital that we recognize prices as well as advantages consisting of return on investment um it'' s. not the only thing that is crucial to us however it'' s it ' s one of one of the most vital points
provided. that we are using taxpayer dollars to money our program as you might understand medicaid composes a not.
unimportant component of the state of texas'' s budget we need to have a balanced spending plan we do our spending plan.
in two-year cycles as well as so it'' s important for we at the medicaid company in collaboration with our mcos.
to demonstrate that there is value in this job and all of us understand that that worth exists it'' s. simply sometimes being able to evaluate that is a little hard so um in the rate of interest of time.
i'' ll stop my remarks there i'' m eagerly anticipating the discussion from the various other panelists.
as well as concerns from the audience and once again i'' m thrilled to to have actually been welcomed to speak.
right here and um thank you so a lot thank you dr we i'' m certain we ' ll have lots of possibilities.
for q a later on so now you understand why don'' t we uh rely on jamie jamie please all right can you.
hear me okay wonderful great great um as they discussed my name is jamie dudensing and i aid.
run the health and wellness health insurance association for texas that includes commercial health insurance plan medicare.
advantage plans and also medicaid took care of care plans and also in some instances all of these kinds of.
strategies are bought programs as well as initiatives that deal with these social obstacles that make.
it harder for individuals to enhance their health and wellness end results i'' m also a registered nurse so.
i like to believe around is you understand the maslow'' s pecking order of demands you know like you'' re never. gon na you'' re never gon na reach true health and wellness if you can'' t help people have food housing and basic.
requirements that they require to make it approximately the leading there'' s a whole lot going on around social term psychological.
health and wellness especially around medicaid handled treatment and also medicare benefit i am mosting likely to concentrate.
on medicaid managed treatment but i'' m happy to address concerns in any one of these 3 type.
of pots of insurance coverage that exist out right here um i'' m mosting likely to start off sort of discussing.
several of the findings that the collective and also the survey that went on this kind of large.
picture what it considers something to have prevalent fostering in medicaid managed treatment what.
are some of the barriers and also barriers that we'' re seeing and also actually kind of end with a positive.
note on the instructions points are going so to type of make it through my notes really quick the the.
survey started with the discovering collaborative um i was attempting to try it was like last fall that.
the um that the collective began and started it'' s currently a bit on.
time out due to covid but it made truly excellent job around obtaining the study done and also the.
monetary wellness structure discovered a variety of truly interesting searchings for one a majority of strategies.
medicaid took care of treatment strategies in texas do screen members for social components of health and wellness they did.
find it was 79 for texas there was likewise a screen the same study happened in california so i.
assume it'' s interesting to have some contrast that in california was 85 percent you'' re truly. discussing a lot of testings that are currently happening by themselves within.
medicaid managed treatment plans in 2 big states currently for texas you did discover that strategies um.
prioritize different components in different ways in texas what we discovered was every single strategy.
was really addressing food instability and transportation in some method as well as 71 reported doing.
housing if you believe concerning it and also in the study cost was the major barrier for attending to housing.
needs um and at the very same time transport and food instability are both issues that.
health plans have some performance history record of working with um particularly transportation.
however even on the food items of this if you think about our medicaid managed care plans specifically.
in beginning plus they'' ve been supplying food benefits for the majority time of the program for i.
mean i i was attempting to think of the length of time it'' s been for at the very least over 10'years that. they ' ve been adding food as an advantage and the long-term care program of medicaid which is.
star plus on this procedure so they they have some knowledge concerning it they know how it functions um it'' s. you recognize they'' re not as scared to invest money in it whereas real estate is definitely far more of an.
expensive venture um the other interesting searching for of the study which i would have believed much more.
of it would certainly have been roi roi or cost savings that actually drove them for.
making choices around their investments in social factors of health but it ends.
up that um since now expense was very low on that as a matter of fact the top 3 variables that.
texas medicaid handled care plans discovered were that they had data mirroring that members needed.
it their mission and worth and exactly how it impacted top quality so cost as well as that general roi part was a.
really reduced item of why they'' re spending what they'' re investing at this time which suggests.
enhancing roi might absolutely increase um adoption of financial investments in social determinants.
of health programs alike programs and also the study also found a few various other things one that of.
course if repaid they would certainly offer more assistance around food transport real estate.
and work um 10 out of the 14 strategies stated that they their social determinants of health.
work benefited the entire community in contrast to individual members alone and i'' m mosting likely to speak.
about that a little concerning this concern versus neighborhood versus person as well as um strategies did.
sight repayment and also other rewards one of the most favorables the federal government might take to enhance.
investment and also social components of health so type of obtaining right into several of the barriers.
that we have found as a part of this issue among training course as i simply discussed is.
moneying it is possibly the easiest means to obtain it going and the largest challenge for why you.
don'' t have prevalent adoption is a funding concern it is hard to track um and information as well as items of this.
is an another barrier with texas medicaid i think specifically and this gets involved in this individual.
versus area situation is that there'' s so much kip down medicaid now i assume that'' s various. so if you take celebrity plus populaces those are the individuals that are um are older or.
have a special needs um that remain in the kind of the medicaid handled care program that has both.
lasting treatment and also severe treatment combined those often tend to have less spin along with children.
with unique health treatment needs program begin kids those programs often tend to have less turn yet if.
you'' re just talking about household you know mommies commonly and also most of the program healthy and balanced.
children you truly have a great deal of churn in the program which makes it actually tough to spend in.
people as well as much easier to purchase areas and afterwards naturally showing roi to shareholders you.
recognize for plans that need to report to investors and also for even neighborhood based plans that have.
reported county courts um you know and also taxpayers that are aid you know a few of those dollars.
come from tax obligation financing items you know you know or us trying to confirm this as dr rimshaw uh ben.
rumshall mentioned is that we have to prove to the state that it'' s great for taxpayers from the state.
side so that roi is a huge piece and also any kind of research info that reveals that return on.
financial investment um is both i think a barrier that we required and yet might be a huge favorable once.
we start having that kind of research study available um the last item of this is there'' s a whole.
whole lot going on in texas strategies are separately doing this yet i the finest means to describe it.
is that it'' s not truly broad view and also it'' s.
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