Will shift in strategy improve Sendero’s financial health?
Yet, Sendero has struggled to find its footing financially, posting millions in losses nearly every year. A major obstacle, President and CEO
To improve Sendero's financial health,
An actuarial report obtained by the Statesman through a Texas Public Information Act request estimated that if the provider could shift 500 members from subsidy programs, it could receive between
BACKGROUND:
READ THE REPORT: NovaRest actuarial report on Sendero
A little more than a month into open enrollment, about 138 people of more than 400 contacted have moved from
Given the unpredictability of expenses incurred by chronically ill patients and looming changes to the Affordable Care Act by a Republican administration set on eliminating it, health care policy experts say the Sendero rescue plan is a risky proposition. But Durkalski said the benefits outweigh the risks, even if Sendero never hits the 500-person benchmark.
"It's a risk if you just focus on the net income, but it's not risky at all when you look at the difference in resources for care that we're bringing down," Durkalski said. "More is always better, but ... it goes back to the general mission that everyone that signs up is one less person uninsured."
The main subsidy program
While those two programs cover basic necessities, the provider network and range of services offered are not as broad as full-fledged insurance, Durkalski said.
Mims has been enrolled in MAP for about 20 years, she said, and the program has helped cover most of her medical costs, including heart surgery, toe amputations following a leg infection and treatment for her diabetes, but it has its limitations.
This year, for example, she wanted to see a pain specialist for foot and shoulder pain, but she was told that wasn't covered under MAP. She also knows more medical expenses are in store in 2019, including physical therapy and treatment for an ongoing leg infection. So, when she was contacted by
"That means a lot to me because I've worked all my life ... and it gets hard to adjust to a fixed income," Mims said. "When you ... don't have (the money for) co-pay, that's embarrassing ... I hope it's (Sendero) what they say it is. I can't wait to try it."
Working to adjust its risk
In initially choosing to wind down Sendero, board members cited its financial difficulties over the years. The provider ended last year
Still, the provider, which this year competes with
Durkalski said Sendero had previously seen its own firm's actuarial reports predicting the results of taking in subsidy program enrollees, but the health district board decided to commission its own such report this fall.
"We expect the financial results of Sendero to improve by adding these additional high-risk, high-acuity score members," Knodel said.
RELATED: Sendero Health Plans to withdraw from Medicaid, CHIP markets
The report for
If those 500 members had relative risk scores 15 times higher than the overall
Lower the number of members shifted from subsidy programs to 200, and Sendero would net about
"It isn't obvious to me, or most of the market, that this is a winning strategy," said
Reaching out for enrollees
Of the 100 people who had signed up as of that date, their average risk score was 26.61. Their average monthly premium would be
COMMENTARY: Why one Sendero board member believes the MAP plan will work
Board member
"The fact that we're above 100, and you have an average risk score that is well above 15, I think speaks well," Geeslin said. "The other key reference point that was driving those earlier results, the forecast we were looking at, was the total number of Sendero members ... It's not just those that are coming in from this program. It's still early yet to be able to say."
Board member
"The numbers are not adding up," Museitif said. "There's a lot of concerns for me in thinking that we're going to meet the 500 based on where we are right now."
In response, Geeslin pointed to the actuarial report showing that even at 200 enrollees, the plan could still yield profits, adding "the higher risk score, the fewer people you need." One of the conditions of Sendero's continued funding was quarterly reports, Geeslin said, meaning the board will see updated projections by January.
___
(c)2018 Austin American-Statesman, Texas
Visit Austin American-Statesman, Texas at www.statesman.com
Distributed by Tribune Content Agency, LLC.
Insurance Brokers Software Market by Technology Enhancements and Demands: Top Key Players Like Vertafore, Applied Systems, EZLynx, Zhilian Software
HCP Upsizes and Prices Public Offering of 15,000,000 Shares of Common Stock
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News