MetroPlus Health Plan is a prepaid health services plan and a wholly owned subsidiary of NYC Health + Hospitals (H+H). MetroPlus contracts with H+H and other providers to offer managed health care services such as Medicaid, Essential Plan, Child Health Plus (CHP) and Medicare Advantage plans for eligible city employees of New York City and daycare workers from city agencies, and private plans through NY State of Health (NYSOH, the state’s online marketplace) for more than 670,000 members. Changes in MetroPlus subscriptions have a direct impact on the financial stability of H+H. As more of its members choose H+H as a supplier, the hospital system generates more revenue, an explicit goal of its strategic plan. This note provides an update on enrollment trends for MetroPlus, as reported in our report: NYC Health + Hospitals Check-Up: The Impact of COVID-19.
Impact of the pandemic on enrollment in the MetroPlus health plan
MetroPlus registrations reached a record high of 670,915, an increase of 159,284 members (31%) between February 2020 and June 2022, the period affected by the COVID-19 pandemic (see Figure 1).
FIGURE 1 – Subscribing to MetroPlus
Nearly 70% of MetroPlus members are enrolled in the Medicaid managed care plan, which has seen the strongest actual enrollment growth of any plan offered. Enrollment in Essential Plan, a subsidized basic health plan offered by NYSOH, had the highest growth rate of any plan at 44% (see Figure 2). In late January 2020, the Secretary of the U.S. Department of Health and Human Services (HHS) declared a Public Health Emergency (PHE) for COVID-19, allowing the Centers for Medicare & Medicaid Services (a federal agency of HHS ) to grant provides for emergency flexibilities to respond to the crisis. The federal Coronavirus Response for Families Act, signed into law in March 2020, authorized tax relief to states that created a requirement to keep most beneficiaries permanently enrolled in Medicaid during PHE. The New York State Department of Health (DOH) is authorized to maintain individuals enrolled in Medicaid, CHP, and Essential Plan without going through their annual renewal while continuing to enroll newly eligible individuals . This provision means that enrollment in these plans will likely continue to increase through the PHE which is currently allowed until mid-October 2022.
FIGURE 2 – MetroPlus Membership by Plan Type
Additionally, MetroPlus has seen an increase in market share in managed care and essential Medicaid plan enrollment in the city. MetroPlus’ share of citywide enrollment in traditional Medicaid managed care plans, which covers the bulk of its members, fell from 14.8% in February 2020 to 15.8% in June 2022, the highest since 2014 (based on February year-over-year data) and the city’s third-largest plan. Enrollment in these plans increased by 34%, while enrollment in all other Medicaid managed care plans offered in the city increased by 24%. MetroPlus’ share of city-wide enrollment in the Essential Plan increased from about 17% to 19% over the same period.
Financial and operational impact of MetroPlus on NYC Health + Hospitals
H+H’s financial stability is influenced by MetroPlus’ ability to continue to attract new members and maintain its current membership, while focusing on better care management. To maximize MetroPlus revenue, H+H is working with MetroPlus to encourage more of its members to use H+H health services and engage its members in routine chronic care management to avoid unnecessary costly use. . Additionally, to meet the needs of MetroPlus members who frequently use H+H hospitals, H+H has also taken steps to ensure members have access to comprehensive care management, including services that meet medical, social and behavioral health needs. For example, in 2017, MetroPlus and H+H created a Housing Working Group to connect H+H patients in need of affordable, supportive housing, including those who are MetroPlus members. As a result, over 300 MetroPlus members were accommodated. Increasing the use of primary care and specialty care services by insured patients at H+H healthcare facilities directly supports H+H’s strategic plan towards fiscal stability.
Despite the best efforts of MetroPlus and H+H, the majority of MetroPlus members use non-H+H healthcare providers. The share of MetroPlus spend in H+H facilities increased from 40% in fiscal year 2019 to 39.1% in fiscal year 2021 and rebounded in fiscal year 2022 to 42.6% , but has not yet reached the H+H target of 45% (see Figure 3).
FIGURE 3 – Share of medical expenses of MetroPlus at H+H
As part of its outreach efforts to attract new members, MetroPlus directs people who are not eligible or cannot afford insurance to the NYC Care program, a financial assistance program that provides a wide range of healthcare services in H+H facilities on a sliding scale. costs.
In line with DOH efforts for statewide Medicaid payment reform, H+H and MetroPlus have entered into an agreement that encourages reimbursements based on the quality and cost-effectiveness of care, from of a model that reimburses according to volume. This value-based payment (VBP) agreement obligates H+H to assume the medical risk of all services covered for all eligible patients under the VBP agreement, even if such care is provided outside of the H system. +H. MetroPlus makes payment to H+H after settling the net amount remaining after paying all medical expenses associated with the VBP arrangement. Risk-sharing liabilities were $199 million and $428 million for fiscal years 2021 and 2020, respectively.
In 2020, during the first wave of the COVID-19 pandemic, MetroPlus ranked the highest of 15 Medicaid managed care plans across the state in the DOH’s Quality Incentive Program which assesses performance covering a wide range of quality measures.
End of federal public health emergency
Upon expiration of the PHE, the continuous enrollment provision will end along with the other enrollment flexibilities granted during the PHE. According to federal guidelines, the DOH will have to resume regular eligibility and enrollment operations and complete all renewals within 14 months, a daunting process as Medicaid enrollment has reached record highs and renewals have not been treated for almost two and a half years. In anticipation of the end of the PHE, the state provided tools to help stakeholders inform enrollees about renewing their coverage. MetroPlus has developed member education and awareness strategies to maintain enrollment growth achieved during the pandemic. It is likely that enrollment in these plans will decline when the membership renewal process returns to normal procedures and some members do not renew or become ineligible for coverage. However, the state’s approved fiscal year 2023 budget includes provisions that expand eligibility for public health plans offered by MetroPlus.
If MetroPlus is successful in adding new eligible members to its plans, it could offset any potential loss of enrollments. Enrollment in MetroPlus is at levels it has never reached before, but this will be difficult to sustain during the end of PHE. MetroPlus, in coordination with H+H, is working to facilitate rapid Medicaid re-enrollment for those who are still eligible and to transition those who lose eligibility to Essential Plan coverage. MetroPlus engages city and state partners to continue to facilitate these transitions through effective use of public benefit data and eligibility flexibilities still available from the federal government to maintain members’ insurance coverage. and prevent interruptions of care. Continued collaboration with New York State remains essential to support this effort.
Additionally, H+H must continue to provide quality care and maintain efforts to improve patient satisfaction, such as reducing wait times for appointments, in order to continue to attract MetroPlus members. These efforts will enable H+H to reach its goal of 45% of MetroPlus’ medical expenses and thus contribute to the successful execution of its strategic plan.