Casey McKeon: ‘Our mission is to improve our efficiency for people who speak other languages’
Casey McKeon, market manager and operating officer for Cigna-HealthSpring, Cigna’s division of Medicaid and Medicare Advantage products in the Philadelphia area, visited AL DÍA headquarters to talk to us and to our readers about a product that can be both complicated and confusing: the Medicare Advantage plan and the role of his company in providing it.
Cigna-HealthSpring manages around 76,000 Medicare advantage plans across the Mid-Atlantic region, 55,000 of those are here in Philadelphia. The company is also the largest provider of dual services in Southeastern Pennsylvania (dual services refer to individuals eligible for Medicare and Medicaid) as well as individuals who are non-dual. “They choose Medicare Advantage products that usually have a low premium, much cheaper than a Medicare supplement product and that offer better benefits than traditional Medicare,” he said.
Cigna-HealthSpring (not just the Philadelphia region) Insures over 2 million members; 500,000 of those are enrolled in Medicare Advantage and more than 30 percent of those are Latino. Still, that is one of the communities Cigna-HealthSpring wants reach better, according to McKeon.
About the hike in the cost of premiums
“We are predominantly focused on Medicare Advantage, so fortunately we are able to base (our fees) on what the government pays us on a yearly basis. Whether we would be increasing cost, reducing benefits, improving benefits, ultimately that depends upon the federal government’s reinvestment for the Medicare Advantage Program. The good news is that in that program specifically for this year, for 2016, the federal government announced that the rate cuts will be less than normal. So, there are still some reductions on the reinvestment we are receiving — mainly through differences in reinvestment methodology (it is a very complicated process) — but overall it was more favorable to the industry compared to years past when we were saying anywhere from 4 to 6 percent, sometimes 8 percent cuts, depending on the market you lived in.”
About how they make money without making premiums unaffordable
“We are paid 95 percent of what the Medicare fee for services cost, basically to run the program itself. There are individuals that do not elect to join a supplement program or to join an MAPD. The federal government figures that population at a certain cost. And every year we ultimately beat out that rate or try to get below it to provide the same level of care but charge the federal government less […] Our business efficiency is in how we operate, our network contracts, our relationship with the physicians, our engagement models. So with our physician engagement models … we are able to actually reduce costs and improve quality; keep our membership healthier and ultimately maintain our margin (which is federally regulated). We have to pay 85 cents of every dollar to the beneficiaries or to benefits, so we have to make our money off the top 15 percent. You have an operating cost in there, depending on how we are operating. Basically your margin can be anywhere from 0 to 5 percent.¨
About life saving drugs and their higher costs
¨I think, in general, if we can ensure cheaper pharmaceuticals for our member it is a huge benefit and that’s something we try to advocate for in our pricing and in our negotiations through pharmacy benefit managers. […] But it some cases the drugs are still very expensive; discounts are volume-based and if it is not a volume drug, you are not seeing big discounts. […] I can tell you right now, in Medicare Advantage, every day I am fighting to find cheaper ways for my members to get their drugs.¨
About the specific strategies to reach the latino community
¨We are predominantly focused on training and education, because Medicare Advantage is extraordinary confusing. It’s a great benefit and a wonderful program, but the fact that you can have Medicare from the government, the fact that you can qualify for Medicare and Medicaid, the fact that there are paperwork and registration challenges around these programs, all of these create confusion. […] We found that the most important thing we can do is just be a leader in the community in education.¨
¨We have a handful of bilingual speakers on my team. We have bilingual case managers, bilingual vendors that do case management for us. Our educators are bilingual, our living well staff, all our front desk staff, some of our practitioners are also bilingual… So we a very large group of individuals in this market that speak Spanish fluently. And that is something we want to do more. So, one of the things I do want to ask today in the interview is that we are actively recruiting nurses and clinicians that speak Spanish. It is something we are always looking for and so although we have individuals that do this today we need more of them.¨
McKeon is part of the group of Spanish speakers the company has and proved it at the end of the interview (when we asked him to switch into Spanish). He told us he learned the language after a few years in Spain (where he studied) and Puerto Rico (where he worked).
Puerto Rico was “a huge part of my professional development, and where I learned a lot,” McKeon said.
We asked him about the differences between providing health insurance in Puerto Rico and to the Puerto Rican community here in Philadelphia. “Besides the cost, which is different,” the main problem Puerto Ricans have to face is the language, he said. “In Philadelphia not many physicians speak Spanish, so patients need some relative or some English speaker to accompany them to the appointments.[…] This is our main mission,” he said, “to improve our service efficiency for people who speak other languages. It can be Spanish, Korean (there is a big Korean community here )… It is important for us to have physicians in our network that can provide care to this population.”
McKeon also highlighted how important is primary care physicians speak patient’s mother tongue. Because he thinks a closer relationship between can be helpful even when they visit and specialist or when then have to go to the hospital. “Sometimes, when they go to the hospital they don’t understand the discharge instructions. They come back home and if it wasn’t because of the support of a primary care physicians they would have to come back to the hospital or they don’t have all the information they should have about their condition.¨ However, in Mckean’s opinion, if there is something really important within this community is the support of the family.