Rethinking Medicare: Turning Data Into Action for Underserved & Aging Populations
Aired: June 26, 2025
About the Webinar
Rethinking Medicare: Turning Data Into Action for Underserved & Aging Populations
Hosted by Alcar Health, this webinar brought together leaders from JAR Insurance Services and ATI Advisory to explore how FQHCs can build meaningful Medicare strategies for dual-eligible and aging populations. With growing policy shifts on the horizon and increasing Medicare Advantage enrollment, the panel discussed actionable steps for health centers to retain patients, improve outcomes, and prepare for long-term sustainability. Topics included demographic trends, policy changes coming in 2027 and 2030, the role of culturally aligned brokers, integration of PACE programs, and practical ways to move from fee-for-service to a more engaged, managed care model.
Chapters
03:49 Understanding the Demographics and Growth of Medicare Duals
13:06 Current Trends and Challenges in FQHCs
18:42 Future Policy Shifts and Their Implications
22:01 Fee-for-Service vs. Managed Care: A Critical Discussion
23:27 The Value of Educated Agents in Medicare Advantage Plans
25:23 Navigating ACOs and Medicare Managed Care
30:44 Understanding Community Needs for Medicare Strategies
34:14 First Steps in Medicare Strategy for FQHCs
41:16 Integrating PACE Programs into Medicare Strategies
42:55 Opportunities for FQHCs in Serving Aging Populations
“We’re not just seeing aging—we’re seeing complexity. Functional, cognitive, and clinical needs are rising fast. FQHCs must prepare now to meet this moment.”
Kersten Burns Lausch
Practice Director, Managed Care Strategy & Operations
ATI Advisory
Kersten Burns Lausch leads ATI's Managed Care Strategy and Operations Practice. She has spent her career working with health plans, states, providers and community partners on issues related to Medicaid, Medicare, health insurance marketplaces, delivery system reforms, and health related social needs. Prior to ATI, Lausch most recently served as Vice President of Business Development with UnitedHealthcare, where she led the organization’s Medicaid reprocurement efforts in Florida and advised health plans on organic growth strategies. Lausch previously served as a Senior Policy Director, working with individual states and Medicaid health plans to provide strategic guidance on emerging policy and program trends. Prior to joining UnitedHealthcare, Lausch served as the Director of Federal & State Affairs with the National Association of Community Health Centers where she led policy strategy and advocacy efforts to enhance the ability of federally qualified health centers to deliver integrated, high-quality care in communities across the country. Lausch has also held positions with other non-profits, including the Center for Health Research and Transformation at the University of Michigan. Lausch received her Master of Public Policy degree in health care from George Mason University and Bachelor of Art degree in political science from Hope College.
Omar Padilla
President & COO
JAR Insurance Services
Omar Padilla is the Chief Operating Officer and President of JAR Insurance Services. With over 30 years in the healthcare industry, Omar’s professional experience includes key and national leadership positions with Health Net, Molina Healthcare, United Healthcare, Blue Shield of California and now with JAR Insurance Services. Omar is responsible for ensuring all company operations run efficiently and effectively. He guides the company’s yearly strategic planning process and serves as one of the liaisons to JAR’s business partners. In collaboration with the team of JAR managers, Omar implements new business opportunities and calibrates strategies for existing projects. As a results-oriented professional, Omar is nimble, embraces technology, and is passionate about improving the existing healthcare system. He strives to educate both healthcare agents and members so they can be empowered to receive the most suitable healthcare coverage available to them. Omar was born in Torrance, California. He is married with three children and now resides in Downey, California, where he enjoys spending time with his sons and wife. Omar’s additional hobbies include hiking, cycling and golf.
Johanna Cazares
Chief Growth Officer
Alcar Health
Johanna Cazares is a distinguished healthcare professional with over a decade of experience in sales, marketing, and business development, specializing in FQHCs. As the Chief Growth Officer at Alcar Health, Johanna delivers solutions rooted in empathetic care, driving growth and savings for FQHCs. A MAGIC Certified Facilitator, Johanna is committed to breaking barriers to quality healthcare, especially for underserved communities. By embodying the patient perspective, she ensures that Alcar Health's contact center augmentation and training programs optimize patient interaction and service delivery. Recognized as a thought leader and change-maker in the healthcare industry, Johanna's innovative approach and passion for service drive her mission to make a lasting impact. Her background includes key roles in national health plans, care delivery organizations, and her entrepreneurial venture which optimizes Medicare Advantage growth, and enhances patient experiences. A Southern California native, Johanna credits her diplomacy and adaptability to growing up as one of twelve children. She is a dedicated mother to three children and a much-loved fur baby named Leo. Johanna is keen to connect with professionals who share her passion for improving healthcare outcomes and experiences. Guided by the mission to empower purposeful leaders, she helps realize Alcar Health's vision of driving a positive impact in healthcare for future generations.
Transcript
Speaker 3 (00:00)
Thank you so much for joining. I'm Johanna Cazares Alcar's Chief Growth Officer. Today's conversation is about moving beyond awareness into action regarding Medicare duals in FQHCs. Before we jump into our webinar today, I do want to take some time to acknowledge the challenging times and stressful situations that our communities are facing today. I'd also like to thank everyone that is working in support of the communities.
with the vulnerable and underserved, most importantly, FQHCs. And in the time where Medicaid is being obscenely threatened, I also want to acknowledge that this Medicare webinar is really intentionally placed at this time so that we can help really start a conversation about Medicare strategy and what that means for FQHCs, the benefits for their patients as well.
So let's go ahead and get started.
I'd like to invite and introduce my guests. We have two fabulous guests today. First is Omar Padilla from JAR Insurance Services. Omar, if you'd like to introduce yourself.
Speaker 2 (01:01)
Yes, hi. First, I want to say good morning. Again, my name is Omar Padilla. I'm the president and COO of JAR Insurance Services. I want to thank the Alcar team for inviting me to be part of this webinar alongside Kristen, who's such an expert in the field of Medicare dual-eligibles and I would say the health industry in general. And for everyone on the line, thank you for taking the time.
as you're representing your respective FQHCs. I think this is a critical time, which presents challenges, but also opportunities. And so welcome for joining and thank you for joining. A few highlights on my background. I have been in the healthcare industry since 1992. And throughout my career, I have been closely connected to the Medicaid and the Medicare industries.
My background includes several years of employment with some of the largest health insurance companies. And over the last 11 years, I have been with JAR Insurance Services. I can tell you that over the last 11 years, we have seen a lot of changes in the industry, but I can tell you that we have seen how Medicare Advantage has picked up momentum.
And a lot of the providers that were not traditionally focused on the Medicare industry, actually are turning more to Medicare Advantage. And so I'm happy to be part of this conversation and be able to provide information that you can find useful, not just for you, but also for the members that you serve. Back to you.
Speaker 3 (02:27)
Thank you so much, Ahmad. And I'd also like to introduce Kersten Lausch from ATI Advisory, who is going to go ahead and take us deep into some data. So Kersten, please go ahead and introduce yourself.
Speaker 1 (02:38)
And thank you for the opportunity to join you all. This is a topic I'm very excited about. And so was great to see that folks have Medicare strategies in place or thinking about it. So excited to hear more from attendees on what some of their activities look like. But as Johanna mentioned, Kersten Loesch, I'm with ATI Advisory. So we're an advisory and research firm. I lead our managed care strategy and operations practice.
And I've been with the firm for only about a year. I actually started my career at a health center. I was a case manager and loved the health center mission. Eventually through my career path ended up working at the National Association of Community Health Centers, working in partnership with the primary care associations and networks around advocacy with states as well as with CMS and a lot of VBP sort of work.
And then I felt like I couldn't be a good Medicaid advocate if I didn't understand managed care and had the chance to work at UnitedHealthcare for many years under Medicaid and dual sign of business. And so I'm really excited to chat today about kind of the Medicare space. And so as Johanna mentioned, I'm gonna share a little bit of just some grounding information and then we'll be diving into the conversation. And so as I'm going through, please.
throw your questions in the chat and we can kind of dive into that together. So I'm gonna go ahead and share here. All right. So first and foremost, just a kind of a point here around just our demographics. Looking at kind of the projected growth in the United States right now by age distribution,
You can see here on kind of this wave growth trajectory age bands, the data is showing that really we're facing significant growth in that age 85 and up population. So that's a growth of 72 % from 2022 to 2035. So rapid growth there. And then also rapid growth in that next age band of 75 to 84. And so, you
over that same kind of time period in a little bit more limited growth for that 65 to 74. So you can see a real shift in age distribution. And so as we're seeing these changes here, think recognizing the functional, cognitive, clinical complexity, medical needs that come with serving an aging population are really important. And so I think as we're kind of
diving through this conversation. think this is a good reminder of, know, just as a country overall, there's kind of a distribution of the population that is gonna have greater needs as we've kind of been talking about for a number of years, but certainly most immediately this next wave of what that really looks like.
And looking at health center patient population here, we've definitely seen over the years, health centers historically we saw oftentimes are around nine, 10 % or so of their patient population were covered by Medicare. And so either Medicare only or both Medicare and Medicaid together as an individual duly eligible for those programs. And we can see here that really that progression
you know, growth has been pretty steady. And so we'll be diving in with some questions a little bit more about this health center growth and some opportunities here. But you know, you can see it's fairly steady, a little bit more growth in Medicare overall, a little bit slower on the duals space. So those who are dual eligible for Medicaid and Medicare.
And just a little bit of level setting. you know, there's this, you know, a large portion of our population is enrolled in either Medicare or Medicaid. Just a reminder of kind of what the eligibility benefits are for those programs here as a friendly reminder. But really, we're going to focus in a good chunk of our conversation, particularly on that 13 million. So those individuals who are duly eligible for both Medicare and Medicaid.
particularly given the population that health centers serve, but also some of the changing dynamics in the marketplace.
And just looking at dual eligible individuals, to become dual eligible, you can become eligible for different reasons. Either you've turned 25 or there's have or living with a disability and have kind of gone through that SSI, SSD process. And so I think looking at the dual eligible population,
We definitely see for those who hold both Medicaid and Medicare coverage, your care needs are oftentimes more complex. So needing more assistance with daily living activities. So it goes kind of like basic activities, cooking, cleaning, taking care of ourselves, those types of pieces certainly face additional social economic barriers.
And then also there's some more complex care needs that are going on with this healthcare for those individuals. And just to kind of lay the landscape a little bit of within Medicare, you have traditional fee for service Medicare and then you have Medicare Advantage. So oftentimes referred to part C that brings in your physician and your hospital services.
And so an individual within Medicare Advantage, you could be part of a standard Medicare Advantage plan. You could be part of a chronic condition special needs plan. So there's these special needs plans that are really a subset. And the chronic condition special needs plans are really focused on tailoring services and benefits to individuals who are managing certain chronic conditions. And so
HIV AIDS, as well as cardiovascular conditions are quite popular. So tailoring plans to those individuals. Then there's ISNP or IESNP. So these are tailored to individuals who are living in long-term care, either in a long-term care facility or receiving that kind of institutional level of care somewhere in the community, or community-based.
space. And then you have a dual special needs plan. And that's for individuals who are dually eligible in both Medicaid and Medicare. Across these plans, DSNPs are the only one that have to have a contract with their state in which they're offering coverage in. And so I think that's one distinction that is going to come up as we talk more about it. But I think also flagging here, individuals who are dually eligible
can enroll in any of these Medicare Advantage plans.
And you'll see kind of over here in that break off of that D SNP area, it gets even more complex. And because really there's different levels of integration between Medicaid and Medicare when it comes to dual special needs plans. And depending on how states have organized their Medicaid programs really shapes kind of what it looks like here. And so you can have
coordination only, so they're just really kind of sharing data. You've got one plan in Medicaid, who is offering your Medicaid coverage and you have a plan in Medicare, very distinct, different. You have then a Heidi SNP, where it's a little bit more integrated, and an individual health plan. They hold at least a Medicaid contract.
and are at risk for either behavioral health services or long-term services and support, so LTSS. So they have some sort of Medicaid risk that they're bearing. And then a FIDESNIP, which is fully integrated. And this is where that Medicaid, DSNP plan is holding that Medicaid risk wholly on that Medicaid side of the house. And so really providing comprehensive services.
And so we've seen within Medicare Advantage a significant increase of enrollment over the years. And you can see in that darker red, those special needs plans has been also kind of growing relative to the growth within Medicare and Medicare Advantage. And particular growth has been in DSNP, and we'll be talking a little bit more later on of why that is.
And you can see here kind of the trajectory of what that specifically looks like for the dual special needs plans of enrollment.
And I think just one item to kind of call out, know, certainly as an individual, they're getting their Medicare, you know, services through a medic, kind of a third party partner, an independent health plan. They are also in addition to receiving, you know, what you would receive under traditional Medicare services, you're also receiving a supplemental benefits. And so there's a lot of different services that can kind of come along within that Medicare Advantage plan.
which is really important for health center patients as you think about the dental coverage that comes with many of these plants, vision, hearing, as well as all other kind of targeted supports around like medically tailored meals, for example, transportation services. And so I'm gonna stop there. That's a lot of information, but we're gonna dive in more so to the dialogue and questions now.
So please feel free to drop any questions in the chat, but I'll turn it back over to Johanna
Speaker 3 (11:44)
Thank you so much, Kersten. That was quite a lot. And I would love to just wrap up the data with a quick poll and we'll pull that up. All right. So what portion of your health center's patients are covered by Medicare? Again, multiple choice. Please go ahead and select whichever number applies to you. If it's zero to 5%, five to 10%, 10 to 15%, 15 plus, or you're not sure.
Let's see here. thought so. Okay, so 15 plus percent. Typically that ranges around 19 to 20 percent. So that looks about right. And 14 percent, not sure. There's some opportunity to dig into your data and to kind of close that question there. But great poll. Thank you so much, everyone, for participating. We'll come back into the conversation now.
And Omar, you're welcome to join back in. I'll go ahead and start off by posting a question to Kersten. I know we just looked at a lot of data on your slides. If we could just break that down a little bit further in terms of, again, focused on the duals. What does the data show us about Medicare and duals and FQHCs today? And how has it evolved in recent years?
Speaker 1 (13:06)
Sure. No, thanks, Joanna. So just as mentioning, we saw, especially when I was at NAC, this is something that me and one of my good colleagues, Susan, would often watch very closely around what is our Medicare UDS data look like this year? What are some of the things that we're seeing there? And it stayed pretty consistent. It's nice to see a more gradual increase in these recent years.
And I think you would expect that number to kind of increase given population dynamics, increases as health center patients age and really being able to be that kind of hub for the community. And I think we've definitely seen that increase. And I think there's certain something to be said about maybe why are we not seeing more of an increase? And I think.
There's a lot of dynamics that shaped that, which I know we'll talk a little bit more about. But I think some of the bumps that we're seeing in recent years, not only tied to those demographic shifts, but also more independent physicians retiring as they get older. Health centers are oftentimes really partnering with some of those providers and being able to bring those health centers into their practice, those patients into their practice.
And then also an increased interest in PACE. A couple of my colleagues really dig in and support folks on their PACE journey. And we've definitely seen increased interest amongst health centers in that space. And so I'm excited to see kind of what that data looks like over the next couple of years.
Speaker 3 (14:30)
Yeah, thank you so much. And before I turn my next question over to Omar, I did want to just mention to all of the attendees, we will be sharing the slides with you so that you have an opportunity to review them and have a conversation about them as well. So please expect those as a follow up to the webinar. Omar, from your experience, what do FQHCs tend to misunderstand or underestimate?
When it comes to the dual population, they already serve.
Speaker 2 (14:57)
Yeah, so I can tell you that historically, as we have been meeting with FQs, there tends to be an inclination to favor the fee for service environment over managed care. However, I can tell you that as I look at the poll that we just had right now, out of the FQs that actually joined this call, it seems like a lot of them do have a plan of action.
and somewhat understand what is their dual population base. But I can tell you historically we noticed that a lot of the FQs, favor that fee for service environment. I can tell you that probably it has to do for the fact that many of them maybe understood that they had more flexibility in serving their
population through that fee for service environment. I think it's possible that historically many of the FQs because they focus so much on the Medicaid population, the Medicare or the dual eligible population was more of an afterthought. And the other component too is that it does take time to formulate a strategy and a plan of action to see how you're going to increase that dual population member base with, you know, focus on Medicare and
and in a close connection to the managed care environment or MAPD plans. And I can also tell you that I think there's been misunderstanding from the FQs as to what is the financial impact, right, of moving away from that fee for service environment. But I can tell you that as we talk to many of the FQs and they begin to understand, you what is the potential that, you know, they can have by building this
mix and also by understanding that given the current environment and the data from Kristen showed it, as we've gone through the last several years, more and more of the Medicare individuals, beneficiaries, they are beginning to join MAPD plans. I think for the first time we crossed that 50 % threshold where more than 50 % of the population of the Medicare population is now in an MAPD plan. So that tells you
that there's a lot of appetite from members for those plans. And part of it is the benefits, right? And many other factors. And so I think that it's really crucial for the FQs to begin to think of a plan of action and be able to have an executable plan of action and work with the right partners so that they can maximize that opportunity. And like you said, especially in this environment right now where it seems like a lot of the health centers have to begin to
diversify that Medicaid line of business with Medicare and others.
Speaker 3 (17:29)
Yeah, thank you so much, Omar. You just reminded me of an interaction that I recently had with an FQHC that we spoke to about six or seven years ago. And at the time, it was a pretty lax strategy. We'll get to that. But what ended up triggering a phone call was our Medicaid patients are turning 65 and they're leaving.
what do we do? And so how can you help us? And so I think, you know, just one thing that I'll throw in here, the misunderstanding of just really not knowing how much patients when they're turning 65 are getting marketed to, are getting approached, and the patient sometimes thinks, once I turn 65 and I have Medicare, I guess I can go somewhere else. I guess I have to go somewhere else.
because there is no direct education to the patient. So I would say that that's a trend that we've seen more recently as well. So switching gears here. So in terms of trends, let's take a look at what's coming, what's on the future state for policy. So to Kersten, I'd like to ask,
What are the key policy shifts coming in 2027 and 2030? And what should FQHCs be preparing for tracking and just paying attention to when it comes to policy?
Speaker 1 (18:55)
Thanks, Renna. You're welcome. So I would say, first is a little bit of, there's a lot of challenge navigating these two systems. And there's a significant opportunity to really increase kind of the patient experience of, okay, I have two cards, which benefits go where? It can be very confusing. And there's additional challenges with access and whatnot.
And so there's been a real interest in improving the experience, particularly for dual eligible individuals. so CMS took action a couple of years ago and past kind of solidified some regulations to kind of push for more integration. so because of that, states are also taking action. But essentially what CMS laid out is that starting in 2027, if you are a parent company and you have a
hold a Medicaid contract and you're offering a DSNP in that same service area, you're only gonna be able to newly enroll individuals who are in your Medicaid plan. And so, that's where that new membership is gonna have to be aligned into both your Medicaid and your Medicare. And then additionally, then in 2030, taking it another step where if you have individuals enrolled in your DSNP,
who are not enrolled in your Medicaid, you're gonna actually have to disenroll those individuals out of your case net. And so states have been taking a lot of different strategies of how to align with these regulations. And so there's a lot of movement and activity, which we can certainly talk more about. I think for health centers and thinking through some of these pieces is definitely patient education. A health center,
patient can enroll if they're duly eligible for those programs, they can enroll really in any Medicare Advantage product. And there's an overwhelming number of Medicare plans available. I think the average for 2025 is 45 plan options per county. And so being able to know, you who can your patients connect with to really support them. There's brokers and partners like Omar, and there's your
state health insurance assistance programs that are really dig into this space. And so I think that's one key is also your plan partnerships. Market dynamics are shifting. So I think as from a policy context at the state level, there's some core pieces. And then I think also at a national level, we are likely going to see some Medicare demos that are really targeting alignment for dual altruists coming out of CMMI. So we actually have a webinar tomorrow and we'll be diving into that topic.
And so it's going to be something to watch.
Speaker 3 (21:35)
If you want to go ahead and pop that link into the chat before we log off, that'd be perfect opportunity. Kersten, you actually took me into my follow-up question, which was, what does that mean for FQHCs, the policy shifts between 2027 and 2030? In California, can say that we are seeing some of that activity already. So my next question, I'm going to go ahead and toss it to the both of you.
Why do you think many health centers, this is something Omar brought up earlier, default to the fee for service model? And is there any hidden cost of that decision to remain fee for service focused over time?
Speaker 2 (22:15)
I can take on that one. So as I was mentioning earlier, I feel strongly that some of the reasons why the FQs default to the fee for service, think is that there wasn't, I think in many cases, because I feel the FQs, they focus so much on that Medicaid population. I don't think they fully understood what were some of the key benefits of the
MAPD plans, not so much financially for the FQ and in terms of their growth and the way that they care for their members, but also what were the benefits for their members, for those beneficiaries. And so we've seen over the years, you know, how sophisticated the MAPD plans have become. you know, Kristen mentioned as well as other options like PACE, which seem to be right now taking off. But also, I think there's also been
sometimes lack of communication with the medical groups, IPAs or helplines that they contract and not understanding, you know, what may be challenges accessing specialists, hospitals, which I know has been an issue for many of the FQs. The other factor obviously is understanding how the reimbursement works. but like I was saying, the richness of the MAPD benefits are...
they are pretty incredible. What we see right now, there can be adjustments year over year, but overall I can tell you when a very well-educated agent is in front of a customer potential prospect, like Kristen was saying, you have an educated agent that has 40 benefit plans to offer to most individuals in most counties. The agent is probably gonna be able to have a
offer that in terms of benefits, it's going to be way richer than what they can get through a fee for service, right? And so right there upfront, you already have a challenge to any provider that is not endorsing that environment. Now, some of the hidden costs that can be associated by sticking with that fee for service environment, like you were saying earlier, Joanna, what happens is that
there are many PCPs now that do endorse that MAPD environment. So as you have FQACs that may not be endorsing it, they have the risk of having one of their members be locked in with somebody else, right? So that by itself is a loss. The other loss is that in many cases, by not having their members join some of this MAPD plans, they're missing out on benefits that are
pretty important for the members, not just the core medical benefits, but also those additional benefits that the MAPD plans offer like food and OTC, dental vision, what have you. So there are those additional costs. And the other component where I think it's a loss is that there are partners that can help the FQHCs grow, which can help with customer service.
managing many of the questions of the beneficiaries and creating that additional resource that if done correctly, the FQHCs can rely on so that they can focus on what's most important to them, starting with the clinical and free their staff to do what is more of the core function of the FQHC.
I think you're a mutagian.
Speaker 3 (25:25)
Thank you so much. I wanna go ahead. Thank you for your answer Omar and time that together. I'd like to go ahead and switch gears and just grab some questions from the Q &A. It looks like some of these questions are related to the presentation slides. So Kersten, you may wanna come off of mute, but I'll go ahead and start with a question that came in from Ralph Silver. And the question is, can you talk about how the...
proliferation of the ACOs affects our considerations about Medicare managed care for the dual eligible patients.
Speaker 1 (25:57)
One, Ralph, it's just very nice to see your name. I wish I was seeing your face too. I think, know, Ralph brings up a great fleet. Health centers that have participated in, for example, like Medicare insurance savings and some of these other models coming to CMMI have done a really nice job in serving Medicare beneficiaries and really achieving savings and demonstrating, you know,
Speaker 2 (26:20)
Dead.
Speaker 1 (26:21)
the value of the health center model in showing up for these patients. We definitely have seen some changes just given obviously one changes in the CMMI model structure and opportunities there of how health centers are thinking about their progression. But also I would say there's, think what we oftentimes and I even hear this sometimes from health centers with their PACE programs.
is just around patient education and what really kind of comes with these different pieces. You can see sometimes some churn hopping back and forth when someone sees, there's, you well, if I sign up with this plan, I'm gonna get this, you know, card that's gonna give me $200 in these sorts of benefits. Well, what are the other, you know, what are you gaining and what are you losing potentially with, you know, that sort of decision?
And so I think just being able to really support some of that education so that folks, you know, as there's a lot of advertisement and a lot of competition, that folks are being able to make choices that are really, you know, fit their healthcare needs and are really supportive there. And so I think it will be really interesting to see, you know, what does the administration come out with? Is there thinking about these Medicare demos? And
where are some opportunities for the health centers to particularly lean in and really be able to participate and continue to demonstrate that value. So I don't know, Ralph, if that helped kind of touched on your question, but that's kind of where some of my thinking is going.
Speaker 3 (27:49)
Thank you so much, Kersten. And I think we've got some chats there. Okay, so here's another question. A couple questions from Dr. Robert Beltran. Again, this is data focused. Which payer, be it Health Net Alignment Blue Shield, in the FQHC population has the largest number of Medicare or MAPD contracted?
with FQHCs.
Speaker 1 (28:15)
That's great. So the data isn't publicly available. There's definitely some ways that our firm can kind of look at some of those pieces. I would say, you know, as far as Medicare and enrollment and Medicare Advantage plans, I think you definitely see, you know, the largest enrollment across the country as a whole. I can't speak for, you know, California specifically, but you see a lot of like, you're United, Humana.
are certainly big players in that space as well as alibants and certainly then also the blues. But there are a lot of folks that are offering, but as far as kind of overall market share nationally, not specifically with health centers, that's where you see a lot of activity. But I think we also have some of that information on our website as well and some pieces. So I'll see what I can pull for you, Robert.
Speaker 3 (29:03)
Thank you, Kersten. And then just another follow up is the data California specific on your website.
Speaker 1 (29:10)
Yes, so you'll see in the question, I provided a link to one of Robert's questions around. We have a duals dashboard that allows you to look at kind of Medicare status, dual eligible status, enrollment by state. And we're actually gonna be rolling out as part of the webinar tomorrow, some additional.
information and layers around some of those dashboards. And so we're pretty excited to share so people can have more of that data in their hands.
Speaker 2 (29:37)
And let me add something to what Dr. Beltran was asking. Like in terms of the accessibility of FQs from some of the health plans and the ones that he had listed are all California or have presence in California. What I can tell you that in general, I think all three of the health plans that you mentioned have a nice mix of contracted FQHCs either directly or through some of their contracted IPAs.
Speaker 4 (29:37)
person
Speaker 2 (30:03)
And now which one has the most is hard to tell. And I have to be politically correct because I noticed that some representatives from those health plans are on the call. But I can tell you that the ones that you mentioned, all three of them have pretty broad access to FQs, not all, but many of them.
Speaker 3 (30:20)
Thank you, Omar. All right, I'm gonna go ahead and jump back into some live questions here for our panelists and then I'll go ahead and pick up back on the Q &A. So feel free to add some more questions there. For Kersten, if a health center leader were to say something to the effect of, we're not focused on Medicare right now, what trend or data point would you point them in the right direction of? Or would you show them first?
Speaker 1 (30:45)
Oh my goodness. You know, it's hard to say, cause I think being able to look at, know, there's these big national trends of what we're seeing and important indicators, like kind of I fleshed on some of the slides. But I think what I would really want to look at and show a health center leader is what's going on in your community. Obviously that's where any health center starts from, and being able to really understand and serve the, you know.
their neighbors, their family, and being able to look at like, what are the demographic shifts in your health center service area? What are you seeing as far as access needs? And what are you hearing from the patient experience as far as those individuals who are aging or who living with a disability? We've had the chance to do, in my previous world, have a chance to work with health centers and disability advocates.
to look at kind of the primary care access for individuals living with disabilities. And there's a lot of opportunity to improve care for the kind of these populations and really look at health equity and health centers, you know, live and breathe that and have been living and breathing that for, you know, well over 50 years. So I would say it's a little bit more of let's look what's going locally.
Speaker 3 (31:56)
Absolutely, thank you. Same question for you Omar, if you have, I'm sure you've had these conversations, we're not focused on Medicare right now, what trend or data point would you wanna go ahead and put in front of an FQHC leader?
Speaker 2 (32:10)
the, so I mean, not only, you know, are we going to a nice influx of people turning 65 over the next 10 years, right? We've been experiencing that wave over the last 10. And so obviously we know that the population of this country continues to age to a point where those over 65 and over 75 and 85 like Kersten was
pointing out in her data is larger, right? So what that means is that just by default, any practice out there is going to experience a larger percentage of people 65 and over. And so that is something that cannot be ignored. And if that is not the base of the population that is going to their health center, I think that it's important to take a look at.
added, right? If they have the right provider mix to take care of that population. So that is something that cannot be ignored. And also we know that the trends show that a lot of the population has more financial challenges, right? So they're more likely to be able to have a connection to an FQHC and they do live in those larger population centers.
So I think it's something that cannot be ignored. And especially given the current trends politically, no matter on what side of the scale you are, we know that there'll be potential challenges with the Medicaid population. And so that's another reason to begin to diversify and put a little more emphasis on that mix, which is leaning towards the senior population.
Speaker 3 (33:49)
Lovely. Thank you, Omar. I'm going to go ahead and just change gears here. Shifting from data to practicality. So what does it look like when an FQHC does embark on a Medicare strategy? Starting with you, Omar, what are the first steps that JAR Insurance Services takes when partnering with an FQHC and really embarking on that Medicare growth and retention journey?
Speaker 2 (34:14)
Yeah, so the, you know, I think for us, one of the first things that we like to do is we like to describe the way that we operate. And so I can tell you that over the years, our focus has always been the underserved Medicare population. And believe it or not, more than 15 years ago,
that was not a focus. Nowadays, we see a lot and more emphasis on that, you know, dual population, but it wasn't the case 15 years ago. That has been one of our focuses since we started, which is one of the reasons why we started this entity, because our organization, because back then we saw that there was a gap. Most of the agencies and agents in the Medicare industry were
not focusing on that dual eligible population. So what we like to explain is the way that we operate. We actually only work with independent agents, meaning that we will only work in areas where we have on the ground agents that understand the community. So part of what we try to instill in the, with the FQHCs that we work is the way that we operate. Then secondly, what we like to make sure that we know is
help the FQ understand that in order to be successful, they have to understand what is their current member mix and specifically identify not only what is their existing Medicare population, what is the number of members that they'll have turning 65 and above and beyond that, what is the makeup of the population that surrounds their location? So we can see what is the full potential.
And so once that is identified, then we can begin to understand what are the goals of the FQ? What is their appetite to grow that Medicare Advantage business and begin to set a plan of action that coincides with whatever is the goal of that organization. And we also need to understand what are the health plan contracts or IPA relationships they currently have so we can develop that plan of action.
and determine if we have a good foundation or if there's additional work that has to be around it. And then the last component is that we will come up with a agreed plan of action that can be possibly executed in phases, depending on the aggressiveness and the current resources that need to be deployed for the strategy. And so that's the way that we like to operate.
And but one thing to never forget is that we always put the member first. And one thing to always keep in mind is that, as you mentioned, there's many options in every market. And in order for a FQ to have a sound plan of action and be able to execute it, we need to have the right benefit plans in place that can be offered to that community.
Speaker 3 (36:55)
Absolutely. And Omar, you've mentioned before and you touched a little bit on it about the different type of agent, a different type of agent that is focused on the underserved population. What does that look like in practice?
Speaker 2 (37:08)
Yeah, the the you know, one thing that that we always come across is that as as we look, you know, in the way that many organizations try to have a marketing plan or or do outreach or what have you, you know, a lot, you know, the first thing that comes to mind is digital marketing, you know, AI and and what have you. And I can tell you that that, you know, that trend in marketing and technology cannot be applied.
to the Medicare Advantage business and to individuals because this is a different type of environment. We are in a relationship type of business. We're dealing with a product that is very difficult to understand, very complex. And the best way to serve that member population is through a very close connection between our independent agents, the staff at the clinic, the health plans, the IPAs, and that member.
technology cannot substitute the ability for someone, especially, you know, given the trends that we see with the low income population, with education levels and what have you. And so the only way that we have operated from the very beginning is that we have on the ground, independent agents that built a personal relationship, not just with the FQ that we work with, but also with the members. And that relationship, the way it starts is that
It will have several touch points. Obviously, there's the initial touch point, which is that initial introduction with the prospective member and the agent. Then there's that education session, conducting that health and financial needs analysis. And once it's all done, it's going through the process of selecting the benefit plan that is more suitable for that individual based not just on
on, like I said, health needs, but also financial needs and other specific factors. And so once the right plan is selected, actually the relationship is just getting started at that point. At that point is when we figure a way to make a connection between that individual and the clinic. And there will be a series of touch points throughout the year
that can help many factors such as star ratings, RAP scores, connection between the health center and the agent in terms of delivering messages that will help in enhancing that experience that the member not just has with the clinic, but also the health plan. And then once the next cycle comes around the next year, making sure that that whole process repeats itself. And so that anytime a member struggles,
with anything, not only do they have the clinic that they can talk to, but there is an agent that is going to be able to connect all the pieces together and ease any questions. It's a complicated process and our job is to make it as easy as possible for our partner clinics, but also for the members. And I can tell you that there's a reason why call centers have a much higher level of disenrollment and dissatisfaction than
than what the members experience through independent agents, especially those that are trained the right way and have the understanding as to what it is that it takes to service a member. And so that's the way that we operate. And I think that formula is probably the only formula that is working for those FQHCs that have a sound plan of action to increase their dual enrollments. in many cases, what
has to be done as customer service, has nothing to do with an enrollment. But when the member has the need to change their current access to care, whether it's fee for service or managed care, because not everything is for everybody, we'll have an agent that will be responsible in putting the placement of the member wherever they need to be and wherever they're gonna get the most out of it. so hopefully that explains the way that we feel
that relationship with the customer has to take place.
Speaker 3 (40:53)
Thank you. I also wanted to just pull in here, PACE, PACE being part of a broader Medicare strategy for a lot of FQHCs. As we've noticed in the experience where you just mentioned that there's not a right fit for everybody. What is your take on and that positioning that JAR takes when a patient has
It was better suited for pace as an example. How would that dynamic play out?
Speaker 2 (41:21)
Yeah, so when we partner up with health centers, medical groups, or even health plans, we have a fiduciary responsibility to do what is best for the members. And in many cases, now we're coming across individuals that are suitable for that PACE program. And so what we do is we do like to partner up with FQs that if they have that program, we'll do everything that we can to help screen and
and provide the referral as needed. It is part of doing the right thing. And in the long run, we know that as we plant seeds and we help customers and make the right or help them make the right decisions, they're gonna refer us to more friends, family members and what have you that realize that they have in us a partner that is always trying to do the best thing. And obviously we do that with full alignment with the health centers that we work with.
But at the end of the day, whatever is happening at the ground, we make sure that we notify our partners so that way they can adjust their processes, their priorities, and their structure, based on the feedback that we are able to provide.
Speaker 3 (42:24)
All right. Thank you so much. I just wanted to throw that in there because I know that there's a lot of PACE programs that are getting established throughout the FQHC community. All right. So let's go ahead and just zoom out for a moment. These shifts aren't just operational. They're about the mission of health centers. And so, Takir, I'd like to pull you back into conversation and ask one
One more direct question here. Where do you see the most significant opportunities FQHCs are missing regarding aging populations?
Speaker 1 (42:56)
That's it. man, I feel like there's definitely a lot of opportunity within the space. I think just as individuals are aging, what does it mean for kind of that retention and thinking about the care model to really meet the population's needs? Additionally, as individuals living with disabilities and who are aging and what do those needs look like?
I think one of the things where I see kind of a gap opportunity is really being able to look at the market dynamics within your state and really look at some of those shared best practices. think one of the things that health centers, a great strength is the camaraderie and network that health centers share. And so being able to talk about, know, there's some health centers that have really engaged in, built out a really stro
Medicare strategy as we've seen for some of our poll members here and being able to share that as either a health center network as through either your HTCN, your PCA, whatever that might be and really talk about how you all are approaching engaging with that aging population I think is a great opportunity right now just as we have a lot of shifts politically, policy.
demographically going on underway and I think being able to really think through the service and the care model and supports for this population and sharing that across your health center networks to get into those needs with each other I think is a great opportunity right now.
Speaker 3 (44:24)
Thank you, Kersten. That's a great closing. I will say that we have about three minutes left. So if anyone has any additional questions to pop into Q &A, let me take a look here. Okay, Dr. Beltran, it looks like we addressed this one, or Omar addressed this one, which was what is best practices for marketing to Medicare fee for service to enroll with FQHCs.
Omar, do you have anything else to add to this one? Do feel like this has been covered?
Speaker 2 (44:53)
Yeah, I think to some extent we covered it, but I mean, the best way to practice is through community-based outreach, local marketing, on the ground. We found that, know, channels such as digital marketing, direct mail, don't really have an impact. People do see it and sometimes they click on it, but they don't react to it.
So the best way to work that FQHC is by being very involved in the community, health fair, senior centers, any community health-based organization that is around that vicinity. That's the best approach and word to mouth. That has been our formula and it's a simple formula, but it takes time and it takes effort to do it. But I think especially with FQHC, that's the formula that works.
Speaker 3 (45:38)
Thank you so much Omar. I'd like to just do one final poll before we close for the day and go ahead and bring that one up.
All right, what has been the biggest barrier your organization faces when engaging dual eligible patients? Go ahead and answer as whichever one applies to you. And if it is other, please go ahead and drop that in the chat.
All right, let's see the results.
All right, 44 % lack of internal capacity. 11 % unclear policy or reimbursement models, limited education outreach, be the strategic priority and other. All right, we will go ahead and close on that note. Before we end, I'd like to just thank everyone for joining. Thank you everyone for partnering and supporting the underserved and vulnerable communities.
Thank you for your interest in our webinar. And we'll go ahead and sign off there. Take care, everyone. We will share the presentation. And if you have any final questions, you can always reach us via email as well. Thank you. Take care, everyone.
Speaker 2 (46:39)
Thank you.
