200-Plus Chronically Ill Patients Sign Up For Private Insurance


AUSTIN, TEXAS — After continual contact with a select group of chronically ill patients receiving care through one of its programs, Central Health officials said they have signed up more than 200 such patients with private health insurance.

The chronically ill patients reached receive car through Central Health’s Medical Access Program (MAP) or on a sliding scale in offering the opportunity to enroll in private health insurance through Sendero Health Plans, the nonprofit community health maintenance organization (HMO) run by Central Health, officials explained.

Those contacts have yielded results, officials said: As of Dec. 15, 228 MAP and Sliding Fee Scale members had enrolled in the new Sendero program, which is categorized as an off-exchange program and not offered through the Health Insurance Marketplace. Central Health is covering the cost of their care and insurance premiums in the new program, according to a press advisory.

By moving patients from MAP and SFS to Sendero, Central Health can leverage local tax dollars for patient care available through the Affordable Care Act’s (ACA) Risk Adjustment Program, officials explained. The program is designed to compensate insurers whose members are sicker and require more services, who then cost more to insure, officials added.

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Working with the Community Care Collaborative (CCC), Central Health’s nonprofit partnership with Seton, Central Health identified patients and analyzed their risk scores. A risk score reflects the level of risk of mortality or disease due to a patient’s health, use of the health care system, and other considerations. By November, Central Health had identified 1,085 patients who could be eligible for the new program whose risk scores were substantially higher than the state average, officials said.

By the Numbers: Central Health Premium Assistance Expansion Program in Sendero

A total of 228 MAP or Community Care Collaborative (CCC) Sliding Fee Scale Members have opted to enroll in the Central Health Premium Assistance Expansion Program (CHAP) through Sendero. Central Health’s cost to cover premiums in fiscal year 2019 is approximately $3 million. The outreach effort included:

1,730 phone call attempts
770 mailed letters
123 home visits attempts

Central Health provided some context to explain their enrollment initiative:

Switching eligible MAP and SFS patients to Sendero is part of a strategy to provide near-term financial stability to Central Health’s nonprofit health insurance company. In September, the Central Health Board of Managers voted to provide $26 million in additional funding for Sendero in Fiscal Year 2019.
Sendero must provide regular outcome measures to the Central Health Board of Managers to prove the strategy is working or the board will cap future funding, which would likely force Sendero to exit the insurance market.
Funding for this program is available for one year. If program funding is no longer available after one year, eligible participants will have the option to return to MAP or the SFS program.