February 8, 2024 • 24 mins
Mike Cheek, CEO with SNP Alliance which is dedicated to improving policy and practice for frail, disabled, and chronically-ill beneficiaries. Cheek came to the SNP Alliance from his role as the Senior Vice President for Reimbursement and Market Strategy for the American Health Care Association/ National Center for Assisted Living (AHCA/NCAL). Prior to this role he was the director of Medicaid Long Term Care for the District of Columbia’s Medicaid agency, the Department of Health Care Finance. In addition, Mike has worked for three state government associations: the state Medicaid directors where he focused on eligibility and long-term care, the state developmental disabilities directors, and the state aging directors. Mike also worked as a consultant for several years, first at The Lewin Group and later at Avalere Health, offering his expertise to states, health plans, pharmaceutical companies, and post-acute and long-term care provider organizations.
https://snpalliance.org/
https://snpalliance.org/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
This week on the Art of Improvement, my guest Mike Cheek, CEO of
SMP, will be talking about insurance, Medicare and Medicaid. You know,
it is a very complicated subject,but Mike is going to explain it all
and make us feel a lot betterabout our choices. My conversation with Mike
is next on the Art of Improvement. Thank you so much for joining us
(00:27):
today. I'm Karen Klaus and Ihave Mike Cheek, CEO of SMP.
Hi, Mike, Hi, howare you. It's good to speak with
you. Absolutely. It's so funnybecause when I got your bio, I
was like, Okay, I readall of this and I still don't understand.
And then when we talked a littlebefore we started recording, I was
like, oh my gosh. Youdeal with people who don't understand things every
(00:51):
single day and help them, andit's just incredible. Can you tell everybody
what is SMP uh. SMP isan organization. Those letters stand for Special
Needs Plans and they are type ofMedicare advantage plants. Medicare advantage plans are
like any other HMO that you mightenroll in through your employer. It just
(01:15):
happens to be Medicare that's the payer, and special needs plans are a type
of Medicare advantage plan, and they'retargeted to folks that have really complex care
needs, so folks that have chronicconditions like multiple cardiopulmonary conditions, in stage
(01:38):
renal disease, or dementia. There'sa third type of coverage that's targeted to
folks that reside in nursing facilities,and then there's an additional type that are
targeted to people that are eligible forboth Medicare and Medicaid. And that's really
(02:00):
important because you know, imagine havingto carry two insurance cards and figuring out
what covers what and what your copayunder this card is and what your copay
is under that card. What theseplans do for people that are eligible for
Medicare and Medicaid duels is that itintegrates those benefits and all the confusing information
(02:25):
that comes with that into a singlehealthcare coverage plan. So you only have
one card that clearly explains what youget under the and and you have a
care coordinator that helps you navigate allof that. So these are special These
are literally special plans that support peoplewith really special needs. And the covered
(02:51):
the populations enrolled are older adults overage sixty five and younger adults with disabilities.
It's incredible because, I mean,needless to say, the baby boomer
population is there is right there,and this is a large population just dealing
(03:15):
with regular insurance, you know,excluding you know, Medicaid and Medicare.
It is hard enough, but ifyou have a special need like one of
the ones you mentioned, I justcan't even imagine even being in that position
to try and make some sort ofdecision that's going to last for a year
(03:37):
or whatever. So how do peopleget in touch with you to start with?
And then how where does it gofrom there? Can you walk us
through? Sure? So you havethe sort of regular annual Medicare advantage enrollment
period called open enrollment. It startsin October and goes until the end of
(03:58):
December, where you can choose tostay in the same plan or you can
choose a different plan if you findone that's just that works just as well
for you, but it's a littlebit cheaper for special need plans. There's
some education that happens through the plansadvertising what they offer that you'll see commercials
(04:20):
now on TV. For special needsplans, and they talk about how they're
different from traditional Medicare advantage plans.There are government programs called called called state
health insurance programs that provide people consultingand advisory services on how to access different
(04:46):
types of public insurance coverage. Andthen some state governments, if you're a
Medicaid, if you're eligible for Medicaid, also will provide you information about these
types of plants. So those arethe primary avenues that people learn about them.
And then there's some actually some providersif you're in a hospital or a
(05:12):
nursing facility under specific circumstances, theyalso can share information about the array of
special needs plans that offer coverage intheir regions. Do you find that people
are hesitant to ask for help orhow is it that they find out about
you? How is it that ifthey did not have you, would they
(05:36):
make decisions? The beneficiaries Medicare andMedicaid beneficiaries they help you, Okay,
And so I'll go ahead. Iwas I was going to say, you
know that those those types of thingsthat I just described as how they find
our member health plans. We're associationthat represent special needs plans. So that
(05:58):
that's how they find to our plans, and then the Special Needs Plans Alliance
or S and P Alliance, we'rethe association that represents these special types of
Medicare plans. And I understand that, but I guess I should ask in
a different way. It's like sometimes when I'm just filling out my regular
insurance at work, they'll say,you can, we have people on people
(06:23):
on standby that'll help you. Andso I get that email. But sometimes
I don't even know what questions toask that would be putting me in a
better position. And so when youwhen you tell me about this, I
would assume I'm not the only personthat gets on the phone with somebody and
(06:43):
says, uh, okay, nowwhat do I do even though I'm asking
for help? Sure? Sure,So when you turn sixty five, or
if you have a disability, typeof disability that qualifies you for Medicare under
some some under some specific circumstances,everyone gets a little handbook called Medicare and
(07:06):
You, and it goes through whattraditional Medicare is, what Medicare advantages,
and it also discusses special news plantsand if one of those resonates with you,
you can call one eight hundred Medicareand they will connect you. They
have call centers all over the countryand they will help you figure out how
(07:30):
to take the next steps with figuringout what will work best for you in
terms of the type of Medicare coverageshe needs. So, Mike, well,
I have to reintroduce you to anybodythat just started listening. This is
Mike Cheeks, CEO of SNP.How did you even get started in this
business? It seems so complicated andso helpful at the same time. What
(07:54):
is your background healthcare policy. I'vebeen in healthcare policy for about thirty years,
working in Medicare, medic I'm sorry, Medicaid with states and with the
federal government. On Medicare, I'veworked with state government associations. There's an
(08:15):
association for everything right. I've workedfor the State Medicaid Directors Association. There's
a Medicaid director in every state I'veworked and I've done. I've worked with
quite a few consulting consultancy firms,work with health plans, pharmaceutical companies and
(08:35):
states. And then I think everybodythat's in healthcare policy should definitely do some
work either with the state government orwith the federal government to understand how things
really work behind the scenes, becauseit is not easy and sure I worked.
(08:56):
I was the deputy director for longterm care in Chronic Conditions with the
District of Columbia Medicaid Agency for sixyears, so I had a lot of
hands on experience with how services aredelivered and how they're paid for. For
folks that have really special needs andare particularly vulnerable. Wow, that is
(09:18):
incredible. I mean, what apath that you have led to today.
That that's really incredible. So whenyou talk about the patients that have these
special needs, are you seeing thatthere is one group that may stand out
more than others that you are seeingneed need your help? All three you
(09:43):
know, all three populations. Peoplethat are living in nursing facilities and are
receiving service is under an institutional specialneeds plan. People with chronic conditions that
are enrolled in a chronic conditions specialneeds plan are all our people that have
really high needs and they're and they'regrowing. The ones that are growing at
(10:07):
the fastest rate are folks that areliving in the community, like down the
street from you or in your neighborhood, that are primarily older adults that are
eligible for both Medicare and Medicaid.That's the fastest growing population, and that
(10:28):
not and therefore sort of the fastestgrowing type of special needs plan. And
that's and that population sort of growthcurve, you know, going up,
is going to continue. So ifI if I had to pick one that
I think really needs a lot ofextra attention to make sure that the plans
really have the flexibility they need todeliver care and services, I'd say that
(10:56):
dual snips special needs plans. Sorry, I'm trying to avoid using government.
That's fine, that's fine. Dualsspecial needs plans are the ones that probably
need a little extra attention right nowjust because of all the needs that everyday
Americans are going to need. Wow, would you say, I'm just going
(11:20):
to ask a specific would you saythat someone with Alzheimer's would be one that
would qualify for this special needs plan? Sure, they're under the you know,
there's under the three types, andI know it's a little confusing.
Under the three types, there's thatchronic condition special needs plan. And one
(11:46):
of the types of conditions that youcan cover under under a chronic condition special
needs plan is dementia. Okay,okay and yep, and that includes Alzheimer's
disease, and they have those plansmust have under the way that the federal
(12:07):
regulations work. The primary care physiciansthat have expertise with delivering care to persons
with dementia and all and Alzheimer's,they have to have other specialty providers that
are targeted to that population, andsometimes they offer services and supports to the
families. That's exactly what I wasgoing to ask you, Yes, yep.
(12:31):
Yet many of them also offer respitservices where someone comes in to give
the family caregivers a break, orthey have assisted living settings in their provider
network networks at providers like hospitals,physicians, and then in this particular instance,
(12:54):
residential support centers where someone can gostay there for a couple of days
to give the family a little bitof a break and then they come home
again. So, Mike, ifif you are not you're not selling insurance,
You're selling your help. Is thatcorrect? I know, I know,
(13:16):
I'm probably like the worst person totry and understand this because I'm still
trying to get my head around it. And so it's not an insurance.
You help people with Medicare and Medicaid. We work with the plans, Okay,
special needs plans that you know differentthey're you know, they're all sorts
(13:37):
of different types of insurers that havespecial needs plans. And we represent the
plans like any other association with likethe American Hospital Association or the American Physicians
Association. Looks like I was saying, everybody's got an association. So we
(13:58):
represent the special needs as plans andwe are their voice, working with the
federal government, the Department of Healthand Human Services, working with Congress.
And then another really important thing wedo is help the plans communicate with each
other on best practice and solving problems. So, you know, people that
(14:20):
have complex and needs you really haveto be really thoughtful and creative about how
about how to meet those needs.So, you know, our our function
as an association, in addition torepresenting their interests with Department of Health and
Human Service and Congress, is servingas this hub for exchanging knowledge, exchanging
(14:46):
best practice to make sure that thesesolutions to care get disseminated among our membership
and that we're really helping to bea powerful voice in improving care for folks
that have complex, complex conditions.I love it that you you pretty much
(15:09):
have worked on both sides. Yes, as a consultant, but the fact
that you have worked for three stategovernment associations and medicaid directors, it really
adds to your knowledge and how you'regoing to help people. I get that,
but so how many people work withyou? I'm not going to get
you on the phone when I call. So how is it that you you
(15:33):
know how many people are helping?Sure, So we're we're a small association,
so we have about we have aboutWe have seven team members in addition
to me. They're three full timestaff. And then we have four really
(15:54):
amazing contractors that are technical experts thatwork with us almost full time. So
they're not so we call them teammembers not contractors because they're with us so
much. So it's that group,uh working with us. And then we
have an amazing like every association hasa board of directors, and we also
(16:15):
have an amazing, really committed boardof directors that you know, if we
have something that we don't understand orwe need somebody to walk us through,
Okay, why is this a problem. We have a great group of board
members that really you know, theydo their day jobs and then they get
on email and phone calls with usto help us figure out things and understand
(16:40):
what why and what we really needto do to support special needs plans in
this bigger health healthcare, healthcare dialogueand space. So how do people I've
gone so far and I didn't evenask you? How do people get in
touch with you? One? Isthis something that anybody across America can get
and to How do people get intouch with you? Sure? So?
(17:06):
So the Medicare Advantage plan world isnot that big. There are a couple
of associations that that represent that representthe healthcare plans, and you know,
if you just search around the community, you'll see you'll find us the Special
(17:30):
Needs Plan Alliance or SNIFF Alliance sn P Alliance. So they find us
that way, they find us theword of mouth. Plans talk to each
other all the time, so there'sa lot of word of mouth internet.
And we have one big open meetingevery year in the fall, and we
do promote that pretty heavily. Andthat's how a lot of people learn about
(17:56):
us. As they see, youknow, the marketing materials out our meetings,
they see the agendas and they decideto come and hopefully have a great
experience. We had great, great, great feedback from our October Fall forum
this year. So they come tothat, they find out about us,
and in an ideal world, theydecide to join the organization. That is
(18:18):
incredible. And so if you aredealing with these special needs plans, do
the actual I guess patients or theensured do they need to also pay a
fee? Is that where the moneycomes from? Is it? Is it
the insurance? How does that happen? So, like any other association,
(18:42):
we're paid dues to participate. Thosedues dollars come from the plants, the
beneficiary. Okay, good. Iwas just going to ask that that's great,
that's great, but how can webe sure and I'm sure you've been
this before, but how can webe sure that you're not giving us a
(19:03):
plan that is because that's the oneyou know and you're working with it.
I mean, how is it that? I mean the people part of it
is a big part also, right, yep. Absolutely, that's the core
of it. And so people cancall and be assured that not only are
they getting knowledgeable direction, which isthe most important, but it's not going
(19:25):
to be one size fits all,go ahead, I'm sorry, Oh no,
please, you get somebody from theBeltway and we like to talk on
it. So what special needs planshave one piece of how they're organized.
It's a little different from a traditionalMedicare advantage plan. They have to have
(19:48):
something that's and I'm going to throwa firm at you, it's called the
model of care. And those modelsof care that each plan has to have.
If you're a special needs plan,it has to be tailored to the
type of people you are enrolling.So that means that if we go back
(20:10):
to the dementia plan we were talkingabout earlier, that means that their model
of care has to have providers thatare in participating that have expertise in supporting
folks with the dimension and as includingAlzheimer's, so primary care physicians that have
(20:32):
expertise in that, psychiatrists. Theyhave to make sure that they're the types
of drugs that they cover that arereally needed, like people with dementia,
are available under their plans. Thatthe folks that help navigate the health plan
services called care coordinators, really understandthe population and how to navigate the services.
(20:56):
So it really is very tailored tothe enroll We built around this model
of care that pulls together all thosedifferent features. No, no, I
get it, And I mean Ineed that so that I can like consume
this information because anytime someone says openenrollment, that's when suddenly I just get
(21:18):
a blank stare. And when everybodyis going to be facing the situation where
they're going to have to pick youknow, Medicare or Medicaid, and I
just can't even imagine how much moredifficult it's going to be in picking a
plan. And so people they canjust I guess, pray that they get
(21:40):
somebody like you to help them.Sure, and you know it's it's you
know, we help the plans,and the plans do the heavy lifting helping
everyday Americans. So you know,the plans that are members of our association,
you are really committed to doing theright thing. You know. Because
of that, we have a greatreputation in Washington representing them because they do
(22:04):
the right thing and they're there.It's easy to go talk to the Fedral
government when you have a great membershipthat's doing great things. Absolutely, that's
really great. And so again MikeCheeks is the CEO of SNP and if
(22:25):
you I know, that you hadgiven out the phone number to Medicaid,
and you know Medicare, could yougive out that phone number? I know
I'm not in that situation, andso I feel like I'm not knowledgeable enough
to even ask you. You knowwhere to go? And I didn't know
that you got an actual letter thatsaid here call us. So maybe you
(22:45):
can help me and and prepare peoplethat are almost there. Sure, So
if you're sixty four and right onthe cusp, or if you're sixty five
now for your over sixty five andyou're trying to make a decision about about
(23:06):
your coverage, you can call oneeight hundred Medicare for some general information and
then they will refer you to statebased organizations that can help you that are
called that are called state health insuranceprograms, so that one in one hundred
(23:26):
number one hundred Medicare. They canaim you at your state health insurance program.
But it's all about the healthcare coverageit's available in your state, and
they'll aim you at what you need, help you understand what you need,
and talk to you about what theoptions are. All right, Mike,
thank you so much for what you'redoing, and it has been a pleasure.
(23:47):
I learned a lot today and Ican't wait. But thank you so
much for coming on. Thank you, Karen. I appreciate the time and
being able to make this important areamore visible. Posts
This week on the Art of Improvement, my guest Mike Cheek, CEO of
SMP, will be talking about insurance, Medicare and Medicaid. You know,
it is a very complicated subject,but Mike is going to explain it all
and make us feel a lot betterabout our choices. My conversation with Mike
is next on the Art of Improvement. Thank you so much for joining us
(00:27):
today. I'm Karen Klaus and Ihave Mike Cheek, CEO of SMP.
Hi, Mike, Hi, howare you. It's good to speak with
you. Absolutely. It's so funnybecause when I got your bio, I
was like, Okay, I readall of this and I still don't understand.
And then when we talked a littlebefore we started recording, I was
like, oh my gosh. Youdeal with people who don't understand things every
(00:51):
single day and help them, andit's just incredible. Can you tell everybody
what is SMP uh. SMP isan organization. Those letters stand for Special
Needs Plans and they are type ofMedicare advantage plants. Medicare advantage plans are
like any other HMO that you mightenroll in through your employer. It just
(01:15):
happens to be Medicare that's the payer, and special needs plans are a type
of Medicare advantage plan, and they'retargeted to folks that have really complex care
needs, so folks that have chronicconditions like multiple cardiopulmonary conditions, in stage
(01:38):
renal disease, or dementia. There'sa third type of coverage that's targeted to
folks that reside in nursing facilities,and then there's an additional type that are
targeted to people that are eligible forboth Medicare and Medicaid. And that's really
(02:00):
important because you know, imagine havingto carry two insurance cards and figuring out
what covers what and what your copayunder this card is and what your copay
is under that card. What theseplans do for people that are eligible for
Medicare and Medicaid duels is that itintegrates those benefits and all the confusing information
(02:25):
that comes with that into a singlehealthcare coverage plan. So you only have
one card that clearly explains what youget under the and and you have a
care coordinator that helps you navigate allof that. So these are special These
are literally special plans that support peoplewith really special needs. And the covered
(02:51):
the populations enrolled are older adults overage sixty five and younger adults with disabilities.
It's incredible because, I mean,needless to say, the baby boomer
population is there is right there,and this is a large population just dealing
(03:15):
with regular insurance, you know,excluding you know, Medicaid and Medicare.
It is hard enough, but ifyou have a special need like one of
the ones you mentioned, I justcan't even imagine even being in that position
to try and make some sort ofdecision that's going to last for a year
(03:37):
or whatever. So how do peopleget in touch with you to start with?
And then how where does it gofrom there? Can you walk us
through? Sure? So you havethe sort of regular annual Medicare advantage enrollment
period called open enrollment. It startsin October and goes until the end of
(03:58):
December, where you can choose tostay in the same plan or you can
choose a different plan if you findone that's just that works just as well
for you, but it's a littlebit cheaper for special need plans. There's
some education that happens through the plansadvertising what they offer that you'll see commercials
(04:20):
now on TV. For special needsplans, and they talk about how they're
different from traditional Medicare advantage plans.There are government programs called called called state
health insurance programs that provide people consultingand advisory services on how to access different
(04:46):
types of public insurance coverage. Andthen some state governments, if you're a
Medicaid, if you're eligible for Medicaid, also will provide you information about these
types of plants. So those arethe primary avenues that people learn about them.
And then there's some actually some providersif you're in a hospital or a
(05:12):
nursing facility under specific circumstances, theyalso can share information about the array of
special needs plans that offer coverage intheir regions. Do you find that people
are hesitant to ask for help orhow is it that they find out about
you? How is it that ifthey did not have you, would they
(05:36):
make decisions? The beneficiaries Medicare andMedicaid beneficiaries they help you, Okay,
And so I'll go ahead. Iwas I was going to say, you
know that those those types of thingsthat I just described as how they find
our member health plans. We're associationthat represent special needs plans. So that
(05:58):
that's how they find to our plans, and then the Special Needs Plans Alliance
or S and P Alliance, we'rethe association that represents these special types of
Medicare plans. And I understand that, but I guess I should ask in
a different way. It's like sometimes when I'm just filling out my regular
insurance at work, they'll say,you can, we have people on people
(06:23):
on standby that'll help you. Andso I get that email. But sometimes
I don't even know what questions toask that would be putting me in a
better position. And so when youwhen you tell me about this, I
would assume I'm not the only personthat gets on the phone with somebody and
(06:43):
says, uh, okay, nowwhat do I do even though I'm asking
for help? Sure? Sure,So when you turn sixty five, or
if you have a disability, typeof disability that qualifies you for Medicare under
some some under some specific circumstances,everyone gets a little handbook called Medicare and
(07:06):
You, and it goes through whattraditional Medicare is, what Medicare advantages,
and it also discusses special news plantsand if one of those resonates with you,
you can call one eight hundred Medicareand they will connect you. They
have call centers all over the countryand they will help you figure out how
(07:30):
to take the next steps with figuringout what will work best for you in
terms of the type of Medicare coverageshe needs. So, Mike, well,
I have to reintroduce you to anybodythat just started listening. This is
Mike Cheeks, CEO of SNP.How did you even get started in this
business? It seems so complicated andso helpful at the same time. What
(07:54):
is your background healthcare policy. I'vebeen in healthcare policy for about thirty years,
working in Medicare, medic I'm sorry, Medicaid with states and with the
federal government. On Medicare, I'veworked with state government associations. There's an
(08:15):
association for everything right. I've workedfor the State Medicaid Directors Association. There's
a Medicaid director in every state I'veworked and I've done. I've worked with
quite a few consulting consultancy firms,work with health plans, pharmaceutical companies and
(08:35):
states. And then I think everybodythat's in healthcare policy should definitely do some
work either with the state government orwith the federal government to understand how things
really work behind the scenes, becauseit is not easy and sure I worked.
(08:56):
I was the deputy director for longterm care in Chronic Conditions with the
District of Columbia Medicaid Agency for sixyears, so I had a lot of
hands on experience with how services aredelivered and how they're paid for. For
folks that have really special needs andare particularly vulnerable. Wow, that is
(09:18):
incredible. I mean, what apath that you have led to today.
That that's really incredible. So whenyou talk about the patients that have these
special needs, are you seeing thatthere is one group that may stand out
more than others that you are seeingneed need your help? All three you
(09:43):
know, all three populations. Peoplethat are living in nursing facilities and are
receiving service is under an institutional specialneeds plan. People with chronic conditions that
are enrolled in a chronic conditions specialneeds plan are all our people that have
really high needs and they're and they'regrowing. The ones that are growing at
(10:07):
the fastest rate are folks that areliving in the community, like down the
street from you or in your neighborhood, that are primarily older adults that are
eligible for both Medicare and Medicaid.That's the fastest growing population, and that
(10:28):
not and therefore sort of the fastestgrowing type of special needs plan. And
that's and that population sort of growthcurve, you know, going up,
is going to continue. So ifI if I had to pick one that
I think really needs a lot ofextra attention to make sure that the plans
really have the flexibility they need todeliver care and services, I'd say that
(10:56):
dual snips special needs plans. Sorry, I'm trying to avoid using government.
That's fine, that's fine. Dualsspecial needs plans are the ones that probably
need a little extra attention right nowjust because of all the needs that everyday
Americans are going to need. Wow, would you say, I'm just going
(11:20):
to ask a specific would you saythat someone with Alzheimer's would be one that
would qualify for this special needs plan? Sure, they're under the you know,
there's under the three types, andI know it's a little confusing.
Under the three types, there's thatchronic condition special needs plan. And one
(11:46):
of the types of conditions that youcan cover under under a chronic condition special
needs plan is dementia. Okay,okay and yep, and that includes Alzheimer's
disease, and they have those plansmust have under the way that the federal
(12:07):
regulations work. The primary care physiciansthat have expertise with delivering care to persons
with dementia and all and Alzheimer's,they have to have other specialty providers that
are targeted to that population, andsometimes they offer services and supports to the
families. That's exactly what I wasgoing to ask you, Yes, yep.
(12:31):
Yet many of them also offer respitservices where someone comes in to give
the family caregivers a break, orthey have assisted living settings in their provider
network networks at providers like hospitals,physicians, and then in this particular instance,
(12:54):
residential support centers where someone can gostay there for a couple of days
to give the family a little bitof a break and then they come home
again. So, Mike, ifif you are not you're not selling insurance,
You're selling your help. Is thatcorrect? I know, I know,
(13:16):
I'm probably like the worst person totry and understand this because I'm still
trying to get my head around it. And so it's not an insurance.
You help people with Medicare and Medicaid. We work with the plans, Okay,
special needs plans that you know differentthey're you know, they're all sorts
(13:37):
of different types of insurers that havespecial needs plans. And we represent the
plans like any other association with likethe American Hospital Association or the American Physicians
Association. Looks like I was saying, everybody's got an association. So we
(13:58):
represent the special needs as plans andwe are their voice, working with the
federal government, the Department of Healthand Human Services, working with Congress.
And then another really important thing wedo is help the plans communicate with each
other on best practice and solving problems. So, you know, people that
(14:20):
have complex and needs you really haveto be really thoughtful and creative about how
about how to meet those needs.So, you know, our our function
as an association, in addition torepresenting their interests with Department of Health and
Human Service and Congress, is servingas this hub for exchanging knowledge, exchanging
(14:46):
best practice to make sure that thesesolutions to care get disseminated among our membership
and that we're really helping to bea powerful voice in improving care for folks
that have complex, complex conditions.I love it that you you pretty much
(15:09):
have worked on both sides. Yes, as a consultant, but the fact
that you have worked for three stategovernment associations and medicaid directors, it really
adds to your knowledge and how you'regoing to help people. I get that,
but so how many people work withyou? I'm not going to get
you on the phone when I call. So how is it that you you
(15:33):
know how many people are helping?Sure, So we're we're a small association,
so we have about we have aboutWe have seven team members in addition
to me. They're three full timestaff. And then we have four really
(15:54):
amazing contractors that are technical experts thatwork with us almost full time. So
they're not so we call them teammembers not contractors because they're with us so
much. So it's that group,uh working with us. And then we
have an amazing like every association hasa board of directors, and we also
(16:15):
have an amazing, really committed boardof directors that you know, if we
have something that we don't understand orwe need somebody to walk us through,
Okay, why is this a problem. We have a great group of board
members that really you know, theydo their day jobs and then they get
on email and phone calls with usto help us figure out things and understand
(16:40):
what why and what we really needto do to support special needs plans in
this bigger health healthcare, healthcare dialogueand space. So how do people I've
gone so far and I didn't evenask you? How do people get in
touch with you? One? Isthis something that anybody across America can get
and to How do people get intouch with you? Sure? So?
(17:06):
So the Medicare Advantage plan world isnot that big. There are a couple
of associations that that represent that representthe healthcare plans, and you know,
if you just search around the community, you'll see you'll find us the Special
(17:30):
Needs Plan Alliance or SNIFF Alliance sn P Alliance. So they find us
that way, they find us theword of mouth. Plans talk to each
other all the time, so there'sa lot of word of mouth internet.
And we have one big open meetingevery year in the fall, and we
do promote that pretty heavily. Andthat's how a lot of people learn about
(17:56):
us. As they see, youknow, the marketing materials out our meetings,
they see the agendas and they decideto come and hopefully have a great
experience. We had great, great, great feedback from our October Fall forum
this year. So they come tothat, they find out about us,
and in an ideal world, theydecide to join the organization. That is
(18:18):
incredible. And so if you aredealing with these special needs plans, do
the actual I guess patients or theensured do they need to also pay a
fee? Is that where the moneycomes from? Is it? Is it
the insurance? How does that happen? So, like any other association,
(18:42):
we're paid dues to participate. Thosedues dollars come from the plants, the
beneficiary. Okay, good. Iwas just going to ask that that's great,
that's great, but how can webe sure and I'm sure you've been
this before, but how can webe sure that you're not giving us a
(19:03):
plan that is because that's the oneyou know and you're working with it.
I mean, how is it that? I mean the people part of it
is a big part also, right, yep. Absolutely, that's the core
of it. And so people cancall and be assured that not only are
they getting knowledgeable direction, which isthe most important, but it's not going
(19:25):
to be one size fits all,go ahead, I'm sorry, Oh no,
please, you get somebody from theBeltway and we like to talk on
it. So what special needs planshave one piece of how they're organized.
It's a little different from a traditionalMedicare advantage plan. They have to have
(19:48):
something that's and I'm going to throwa firm at you, it's called the
model of care. And those modelsof care that each plan has to have.
If you're a special needs plan,it has to be tailored to the
type of people you are enrolling.So that means that if we go back
(20:10):
to the dementia plan we were talkingabout earlier, that means that their model
of care has to have providers thatare in participating that have expertise in supporting
folks with the dimension and as includingAlzheimer's, so primary care physicians that have
(20:32):
expertise in that, psychiatrists. Theyhave to make sure that they're the types
of drugs that they cover that arereally needed, like people with dementia,
are available under their plans. Thatthe folks that help navigate the health plan
services called care coordinators, really understandthe population and how to navigate the services.
(20:56):
So it really is very tailored tothe enroll We built around this model
of care that pulls together all thosedifferent features. No, no, I
get it, And I mean Ineed that so that I can like consume
this information because anytime someone says openenrollment, that's when suddenly I just get
(21:18):
a blank stare. And when everybodyis going to be facing the situation where
they're going to have to pick youknow, Medicare or Medicaid, and I
just can't even imagine how much moredifficult it's going to be in picking a
plan. And so people they canjust I guess, pray that they get
(21:40):
somebody like you to help them.Sure, and you know it's it's you
know, we help the plans,and the plans do the heavy lifting helping
everyday Americans. So you know,the plans that are members of our association,
you are really committed to doing theright thing. You know. Because
of that, we have a greatreputation in Washington representing them because they do
(22:04):
the right thing and they're there.It's easy to go talk to the Fedral
government when you have a great membershipthat's doing great things. Absolutely, that's
really great. And so again MikeCheeks is the CEO of SNP and if
(22:25):
you I know, that you hadgiven out the phone number to Medicaid,
and you know Medicare, could yougive out that phone number? I know
I'm not in that situation, andso I feel like I'm not knowledgeable enough
to even ask you. You knowwhere to go? And I didn't know
that you got an actual letter thatsaid here call us. So maybe you
(22:45):
can help me and and prepare peoplethat are almost there. Sure, So
if you're sixty four and right onthe cusp, or if you're sixty five
now for your over sixty five andyou're trying to make a decision about about
(23:06):
your coverage, you can call oneeight hundred Medicare for some general information and
then they will refer you to statebased organizations that can help you that are
called that are called state health insuranceprograms, so that one in one hundred
(23:26):
number one hundred Medicare. They canaim you at your state health insurance program.
But it's all about the healthcare coverageit's available in your state, and
they'll aim you at what you need, help you understand what you need,
and talk to you about what theoptions are. All right, Mike,
thank you so much for what you'redoing, and it has been a pleasure.
(23:47):
I learned a lot today and Ican't wait. But thank you so
much for coming on. Thank you, Karen. I appreciate the time and
being able to make this important areamore visible. Posts
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!