In an unprecedented year for health care around the world, the Oklahoma Health Care Authority has had to adjust to serve Oklahoma's significant uninsured population. Adding to that challenge was Oklahoma voters' decision in June, through Constitutional Amendment, to require the state to expand Medicaid next year. In this week's Capitol Insider, Kevin Corbett, the chief executive officer of Oklahoma's Medicaid agency, tells KGOU's Dick Pryor and eCapitol's Shawn Ashley how the Oklahoma Health Care Authority is handling 2020 with an eye toward 2021.
Dick Pryor: This is Capitol Insider, your weekly look inside Oklahoma politics, policy and government. I'm Dick Pryor with eCapitol news director, Shawn Ashley. Our guest is Kevin Corbett, chief executive officer of the Oklahoma Health Care Authority, which is Oklahoma's Medicaid agency. Kevin, good to have you with us again.
Kevin Corbett: Great to be with you again.
Dick Pryor: We last talked over a year ago, just over a year ago, when you were starting in this position. A lot has happened since then in health care. How has coronavirus affected the work at the Health Care Authority and the services you provide?
Kevin Corbett: That’s a very good question. And I'm sure I'm not alone in this dilemma, but quite frankly, it's been one that allowed us to really demonstrate the ability to be resilient, to be agile and really creative.
We have six hundred employees here that work every day serving our members - over a million members - is our number one commitment. When coronavirus hit and we had to do something different is that we didn't want to interrupt or have any impact on our members in the services we provided. So, we've had a number of people that had to be very creative in how they use technology, how they interact with their teammates. But I got to tell you, Dick, I couldn't be more impressed and more proud of our team that we didn't skip a beat. We shared with our board and over the course of the last year how we were performing in terms of serving members and the statistics and the results are amazing, quite frankly. And so, I would say it's been a challenge, but it's not one that we shied from. One of our various principles is to be solution oriented. And I got to tell you, I think our team has really stepped up and demonstrated the ability to be the problem solvers.
Shawn Ashley: COVID-19 pushed up Oklahoma's unemployment rate and high unemployment usually leads to increases in Medicaid enrollment. Has that happened this year in Oklahoma?
Kevin Corbett: Yeah Shawn, it has. Quite frankly, it's happened for a couple of reasons. One is unemployment in itself. Now that has moderated, as you know, quite a bit over a very short period of time. One of the things that we've been fortunate at the Health Care Authority with is our federal partner’s participation. We get a substantial amount of funding from the federal government to serve our Medicaid members and by virtue of coronavirus, they enhanced their participation. One of the things that required, though, which I think is great for our membership in citizens, is that one of the commitments we made by receiving that enhanced funding is that we agreed not to disenroll members when they become ineligible. So, our membership count is up more due to the enrollment of members that under normal circumstances would probably have lost their eligibility. They have maintained that we have seen a little bit of an employment increase by itself, but that is by far is the largest percentage of the increases because of the disenrollment provision that we put in place.
Shawn Ashley: Has that increased the stateside cost of Medicaid funding?
Kevin Corbett: I would say not, quite frankly, because the amount of federal partnership that we received was based on our entire Medicaid program. So, we've got more share for our entire program, and that has really compensated for any increase we might have experienced in Medicaid costs. As you know, early on in the coronavirus conditions there was a lot of tempering of health services - called non-emergent care and things of that nature. So, we really saw a dip, quite frankly, in the amount of claims that were occurring early on in the coronavirus. That, coupled with the enhanced funding from the federal government, really was a financial success for us, if you will.
Dick Pryor: Kevin, last June, voters approved Medicaid expansion in Oklahoma, which must occur by July 1st, 2021. Where is the Health Care Authority in terms of planning for that?
Kevin Corbett: Great question, Dick, and if you recall, I think when we talked over a year ago we were talking about expansion.
Dick Pryor: We were.
Kevin Corbett: We were talking about Sooner Care 2.0. What that did for us has put us in motion to really be prepared for expansion. We were actually planning for expansion July 1, twenty (2020). So, a lot of those efforts have really beared fruit for us in terms of being prepared for July 1, twenty-one (2021). The ability to enroll close to two-hundred thousand new members is something that we certainly didn't take lightly, and so I would say hats off to our team. They've done a great job of being prepared. So, when that becomes reality (to) us, I think we'll be well prepared to enroll and start serving an additional population.
Dick Pryor: Do you have enough money from the state?
Kevin Corbett: Always a good question. The estimates that we have provided to the governor as well as the legislature on this expansion is about a hundred and sixty- four million dollars the first year. That's our 10 percent share of the overall cost that we're estimating for this new population in year one. The federal government in this case is even providing more funding for this population than our normal population. That’s a 90/10 sharing ratio, so for every dollar that's required to serve this population, the federal government will pay 90 cents and we'll pay 10 cents. But that 10 cents results in about one hundred and sixty-four million that we have to be able to fund on our own.
As you know, State Question 802 required that expansion does occur and the funding has to be provided through the legislature. So, we've been working with the legislature in terms of alternative funding sources and things of that nature, so that is still not concluded yet. So that is (what) I'll call one contingency that still remains unresolved is the funding. Operationally, I would say that we're ready. Funding - I'm confident that the legislature will do what it needs to do to fund the expansion.
Shawn Ashley: The Oklahoma Health Care Authority simultaneously is considering implementing a managed care plan for the state's Medicaid program. Why are you looking at that approach?
Kevin Corbett: You know, we've been looking at that really ever since I arrived here. But I would tell you, expansion probably put a catalyst to that. When you think about that the Health Care Authority today serves a million members, has a budget of about six billion dollars total, adding the two-hundred thousand new members will take us to about a seven-billion-dollar organization. And it's always been my view and it's been the passion of our team is our number one focus is improving the health of our members. And it is no surprise when you look at where we are today that something needs to change.
As I've shared many times, you know, the state is ranked somewhere in the neighborhood of forty-six to forty-seventh in health outcomes, largely due to things like obesity, physical inactivity, drug overdose deaths, cardiovascular deaths and other deaths. And again, those are not unique to the state of Oklahoma. But when you compare our rates of those health conditions to other states, it would suggest that we're not being as successful as we need to be. And so, it was incumbent upon us at the Health Care Authority when we have the ability to serve a million of our four million citizens is to ask the question, “what do we do different?” And we think, one, focus on health outcomes and change the way we deliver health and health services to be a participant in driving health outcomes higher than where they are today. That means we have to look at our delivery system.
Right now, our delivery system has been in place for many, many years, probably decades. And we've looked at other states, forty other states, to be particular, of how they were being successful and doing things differently. And the thought is, is that we really needed to move what we do today to what I'll call a kind of coordinated care system and look to others, quite frankly, that could be a participant with us and partner with us that have capabilities, experienced investment capabilities to be a part of our journey to improve health outcomes. And that led us to the consideration of a managed care environment.
Forty other states use it. Admittedly, the state used it decades ago, was not successful. A lot of things have changed in the 20-plus years since the state had attempted that. And I'm confident with the work that we've put in, at least in the process of developing what I'll call a request for proposal to engage others to participate with us, that we thought about all the things that others have had either challenge on and success with and have taken all of those into consideration.
We think it's part of the solution that we need to invest in. I looked at the statistics, quite frankly, every day to see where we are. The governor's got a strong ambition to be a top ten state, and that's in health care as well. And if you look at where we are on all the meaningful measures, we are top ten in many of them, unfortunately, the wrong things. And we need to do something about that. I think about that in terms of what are the consequences of not being top ten. And there's a lot of things that go into that. There's a lot in it for the state. There's a lot in it for our citizens. But more importantly, if you think about, at least the members that we serve at the health care authority, we think that in terms of quality of life and what that's robbing them of, if we don't focus on trying to improve health for them and others.
So, we think the managed care organization, care coordination, where we are all looking for outcomes rather than activities, is the right answer. We’re right in the process of seeing how others will respond to us in terms of their interest in partnering with us under our terms, under our conditions, under our expectations, we're optimistic. Those proposals that are expected to be received here in short order, December 15th, will take a couple of months to evaluate what we receive, and do we have viable partners that we can align ourselves with?
Dick Pryor: Medicaid expansion is now in the state constitution. What hurdles have to be overcome to implement an expansion plan by next July first, in broad terms?
Kevin Corbett: In broad terms, I mean, we obviously have to be prepared for an expansion of a population that's far greater than, as far as the Health Care Authority, far greater than the normal enrollment activity that will occur on every single month. But the reality is, as I looked at it, is this is an extension of what we do every day. We engage with, we enroll with, we determine eligibility for our members day in and day out. So, the systems and the processes that we're going to have to deploy are not going to be unique to this population. We're going to be able to fold in this group very much like we do with all the other members that we have. It is a large group. So, we have to think about volume. We have to think about just the uptake that's going to occur.
Probably the one thing, Dick, that I would say that we're looking at is making sure that we have engagement with these potential members and we have engagement with our provider group that are prepared to serve this group. Because this is the uninsured group and what typically we have seen the uninsured have used for health care services, if at all, is the hospital system. So, we're talking about primary care providers and other types of providers that will now have the opportunity to serve a population that they probably have not been familiar with. So, we're looking at physician recruitment and provider recruitment to ensure that we have a sufficiency of providers that can serve this additional membership that we're going to have.
Shawn Ashley: You mentioned you currently have one million members at the Oklahoma Health Care Authority. As we move into 2021, one of the big health stories will be the COVID-19 vaccines. What role do you expect the Health Care Authority to play in the vaccination effort?
Kevin Corbett: As far as our role has typically been, one to be a provider of coverage and compensation for that activity. Obviously, we engage for everything that we do, in terms of delivering health services, we look to our sixty thousand plus providers to assist us in that. It’ll be the same for vaccines. We do it today through partnership with the health department. Our role has been in making sure that there is compensation for dispensing of those vaccines. For those that do that on our behalf, that will be the same for the COVID vaccine. We're working very closely with the health department to understand the plan, understand the distribution, timing and the provider group that will be assisting in that vaccination process and making sure that they are appropriately compensated for the administration of the vaccine.
Dick Pryor: There is a lot of work to be done in the year ahead.
Kevin Corbett: There is, Dick, but it's all exciting and quite frankly, I keep looking at it from the standpoint of it is time. It is time to make a real commitment to driving health outcomes for the state. It's broader than most think in terms of what that would achieve. But I think about the opportunities that might be lost if we don't do this. And so, we look at as an opportunity. It is a challenge to be, to be honest with you, but that is one that we are excited to take on. We’re talking about Medicaid expansion. We're talking about managed care. We're talking about a health information exchange for the state. All things that, you know, with hindsight probably should have been in place years ago. But we have the opportunity to do it and we're excited to do it.
Dick Pryor: Kevin Corbett, CEO of the Oklahoma Health Care Authority, thanks for joining us on Capitol Insider.
Kevin Corbett: Great to be with you, Dick.
Dick Pryor: If you have questions, e-mail us at email@example.com or contact on Twitter @kgounews and @ecapitol. You can also find us online at kgou.org and ecapitol.net. Until next time, with Shawn Ashley, I'm Dick Pryor.