Clever Care Health Plan: Lee said the business is concentrating on increasing despite the competitive market and the decline in investment in health IT. The Medicare Advantage platform has protected them from some of the recent funding market turmoil.
“We have made technology investments, but they have primarily served to enable tasks like automating translations of other languages. Our primary goal is to serve an underrepresented community as a fundamental Medicare Advantage health plan. I’m not starting a tech business.
I believe those are the main reasons why we’ve seen so much interest from top-tier investors like GV, along with the significant growth that we’ve seen in Southern California, which is a difficult market, but the fact that we’ve been able to get the type of growth that we’ve seen over the last few years,” he said.
According to Lee, who has worked at other MA plans, the majority of big Medicare Advantage plans target a larger, English-speaking clientele.
Clever Care Health Plan
The majority of these plans are integrated, offer a variety of services outside of Medicare, offer commercial insurance policies, and make use of their current networks.
They are quite focused on expanding inside their core communities, despite the fact that they are obviously aware of all these different cultures, languages, and races. A huge incumbent finds it difficult to change course and attempt to comprehend all the subtle differences between these several filters, according to Lee.
He continued, “As an illustration, the herbal medicines used by the Korean population are very noticeably different from our Chinese population, our Vietnamese population, our Filipino population, and so on.”
Because of the cultural variations, “the way you approach these individuals from a care management viewpoint and how you talk to a male or female member are also very distinctively different by race. These are the kinds of details that make what we’re doing stand out that we’re really learning and incorporating into our CRM [customer relationship management] system as well as training our bilingual staff members.
In the future, Lee sees chances to provide its distinctive holistic approach to various elderly groups.
“As we continue to develop our technological platform and our capacity for automating back office operations. I really believe that eventually, we’ll be able to grow even more. For the time being, we’re concentrating on our core membership to ensure that we genuinely get this right and discover what they find appealing about Clever Care before we extend further,” he said.
Clever Care Health Plan
In his words, “Having that focus, being able to provide that level of service, being able to provide the type of benefits and providing the right provider network to the members, it’s really all those things that are driving interest in the health plan.”
The business signed a collaboration agreement with Allied Pacific IPA in November. This provider network, which serves more than 350,000 patients in the broader San Gabriel Valley area, is one of the biggest in Southern California. The business announced alliances with Alpha Care Medical Group, which serves communities in the Inland Empire, and Accountable Health Care IPA, which covers Downtown Los Angeles and the wider Long Beach region of Los Angeles County.
Federal authorities are advising states to take every precaution to prevent significant coverage losses as they work through the large backlog of Medicaid eligibility determinations.
The goal of the agency is for states to meet and exceed federal requirements in limiting the number of people who lose healthcare coverage, according to Dan Tsai, deputy administrator of the Centers for Medicare & Medicaid Services (CMS) and director of the Center for Medicaid and CHIP Services, in remarks to reporters on Wednesday.
Tsai stated during the press conference that “we put out additional policy, levers, and strategies for states that all get at reducing procedural termination rates, and our hope is that all states take up every one of those policy flexibilities.” “If all states did that, we would see fewer procedural terminations, and more qualified individuals would continue to have coverage. The basic fact is that this is the reason we have been pleading with and working in tandem with states to… make sure they are adhering to every federal obligation.
When it comes to Medicaid enrollments, “we have been emphasizing it is not enough for states to simply follow federal minimums,” he continued.
As redeterminations resume, Elevance Health loses 135K Medicaid enrollees in the second quarter.
The yearly renewal windows for people presently enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) were suspended during the COVID-19 public health emergency. As long as states committed to keep everyone on the Medicaid rolls during the pandemic, Congress doubled the federal matching rate for state Medicaid payments. After Medicaid dis enrollments in February 2020, eligibility redeterminations started on April 1.
Since December, Congress has mandated that states provide CMS with monthly statistics and given CMS the authority to use enforcement measures to make states accountable. States must submit corrective action plans; if they don’t, CMS has the right to punish them.
CMS Administrator Chiquita Brooks-LaSure stated, “Now that states are resuming renewal, we are all laser-focused on ensuring that people can stay connected to health care coverage.”
Prior to the epidemic, 17 million people annually would lose their Medicaid and CHIP coverage, including lots of children and families who were still qualified but ran into administrative difficulties.
According to KFF, there are now close to 95 million people enrolled in Medicaid and CHIP, placing the program in an “unprecedented” scenario.
Clever Care Health Plan
There is a chance to keep individuals on coverage despite the churn, Brooks-LaSure said, pointing to efforts the Biden administration has done to ensure there are health plans accessible in the Affordable Care Act (ACA) marketplace that cost less than $10 a month.
According to Tsai, “business as usual” in the past involved many eligible individuals losing coverage for a while due to administrative complications and eventually regaining it. “We don’t think that should be the status quo,” the speaker said.
According to 33 states and the District of Columbia, at least 3 million Medicaid participants had been dropped from the program as of July 19 KFF reported. Across all states with data, 74% of customers had their coverage canceled due to administrative issues such as incomplete or out-of-date renewal packets or contact information. Many of these individuals might still be qualified for Medicaid or other types of insurance.