December 21, 2018
(Austin) – Central Health has been contacting a select group of chronically ill patients who receive care through its Medical Access Program (MAP) or on a sliding fee scale (SFS) to offer the opportunity to enroll in private health insurance through Sendero Health Plans, Central Health’s nonprofit community health maintenance organization (HMO).
As of Dec. 15, 228 MAP and Sliding Fee Scale members had enrolled in the new Sendero program, which is categorized as an off-exchange program and not offered through the Health Insurance Marketplace. Central Health is covering the cost of their care and insurance premiums in the new program. By moving patients from MAP and SFS to Sendero, Central Health can leverage local tax dollars for patient care available through the Affordable Care Act’s (ACA) Risk Adjustment Program. The program is designed to compensate insurers whose members are sicker and require more services, who then cost more to insure.
Working with the Community Care Collaborative (CCC), Central Health’s nonprofit partnership with Seton, Central Health identified patients and analyzed their risk scores. A risk score reflects the level of risk of mortality or disease due to a patient’s health, use of the health care system, and other considerations. By November, Central Health had identified 1,085 patients who could be eligible for the new program. Their risk scores were substantially higher than the state average.
By the Numbers: Central Health Premium Assistance Expansion Program in Sendero
A total of 228 MAP or Community Care Collaborative (CCC) Sliding Fee Scale Members have opted to enroll in the Central Health Premium Assistance Expansion Program (CHAP) through Sendero. Central Health’s cost to cover premiums in FY 19 is approximately $3 million.
The outreach effort included:
– 1,730 phone call attempts
– 770 mailed letters
– 123 home visits attempts
Switching eligible MAP and SFS patients to Sendero is part of a strategy to provide near-term financial stability to Central Health’s nonprofit health insurance company. In September, the Central Health Board of Managers voted to provide $26 million in additional funding for Sendero in Fiscal Year 2019.
Sendero must provide regular outcome measures to the Central Health Board of Managers to prove the strategy is working or the board will cap future funding, which would likely force Sendero to exit the insurance market.
Funding for this program is available for one year. If program funding is no longer available after one year, eligible participants will have the option to return to MAP or the SFS program.
MAP and SFS members with questions should contact 512-978-8130.