1. Health Care Challenges in Providing Services to Latinos
Ken Janda
President and CEO
Hispanic Health Coalition 2017 Latino Health Summit
November 29, 2017
non-profit HMO
Affiliated with Harris Health
serving over 450,000 Members
20 counties of Southeast Texas for STAR and CHIP

2. About Community
Non-profit Health Maintenance Organization licensed by the Texas Department of Insurance
Affiliate of the Harris Health System (Houston’s public hospital system)
Serves over 440,000 Members in the following programs:
Medicaid State of Texas Access Reform (STAR) Program
Children’s Health Insurance Program (CHIP)
Health Insurance Marketplace Plans offered under the ACA.
Regional HMO coverage for State of Texas employees (ERS).
Administrator for multiple collaborative safety net projects.
Surplus goes to community benefits program

3. Service Area Map

4. Key Latino Health Issues
Diabetes, heart disease & other chronic conditions on the rise
Social influences on health: education, neighborhoods, income, diet, exercise, etc.
Lack of Hispanic and Spanish speaking health care professionals
Low understanding of connection between access to health care and health insurance
A year of care for an asthmatic child would likely be our next best opportunity in Medicaid
As our Marketplace business has grown, we now have opportunities for other bundled payments in more traditional areas of hips, knees, CABG, etc.

5. Health Policy on One Page
Health ≠ Health Care ≠ Health Insurance

6. Community’s Safety-Net Focus

7. Uninsured Rates by StateTX US
I wouldn’t put this in here but I just wanted to give the option. It’s a neat graph. CA NY MA
Source: U.S. Census Bureau, 1-Year American Community Survey

8. Key Latino Health Insurance Challenges
Growing Hispanic population (over half of Community’s members): generally younger and lower income
Hispanic populations have the highest uninsured rate
Independent contractors/own their own businesses
Work for small employers that don’t offer coverage
Part-time, multiple jobs
Texas did not expand Medicaid to adults under the ACA
If you don’t have employer-sponsored insurance, ACA requires purchase of individual coverage
Penalty for no insurance is still in effect (2.5% of income)
Open enrollment – November 1st through December 15th
Good news: four carriers in Houston, lots of options, subsidies available
Everyone needs insurance
A year of care for an asthmatic child would likely be our next best opportunity in Medicaid
As our Marketplace business has grown, we now have opportunities for other bundled payments in more traditional areas of hips, knees, CABG, etc.

9. Why Coverage Matters Coverage: Equals access to healthcare in the U.S.
Provides catastrophic financial protection
Is preferred by patients (holistic care, one-stop shopping, medical homes)
Improves care coordination across providers
Allows consolidation of mental and physical health
Creates organized eligibility to track and report costs and health outcomes
Improves population health management
Facilitates paying providers for value (money follows the patient)
Strengthens accountability...patient, provider, payer
It just costs too much
Coverage should be universal. All Americans should be accountable for their own health and paying for healthcare services.
The unpopular individual mandate is really about personal accountability, not government control.

10. How the ACA Helps Individuals Get Access to Care (in Texas)

11. What Does the Future Hold?
President Trump and Republicans have spent too much time saying “repeal and replace” ACA, but no consensus on replacement…who knew it was so complicated?
Optimistic Ken hopes for bipartisan solution with no major damage, simplification and opportunity for Texas to move forward in reducing costs and the uninsured
Pessimistic Ken still sees a “skinny” version of BCRA passing with really bad provisions including Medicaid cuts (block grant the whole thing)…we could go backwards and increase the number of uninsured
Advice to everyone:
Must keep doing what you are doing now, until law changes
Be ready to flex when laws and regulations change

12. A Health Policy Home Run
Third Base:
Simplify funding and administration of programs
Second Base:
Coverage for everyone
Home Plate:
Slow healthcare cost increases through provider payment reform
First Base:
Personal accountability for health and financing

13. Questions & Discussion
Contact Information:
Ken Janda
(713)