AFTERMATH LINGERS: InnovaCare Health Helping Puerto Rico post Hurricane Maria

Richard Shinto, MD, MBA, is president and CEO of InnovaCare Health and MMM Holdings, which offers managed healthcare services and operates leading health plans in Puerto Rico, namely MMM Healthcare, Inc. (MMM) and PMC Medicare Choice, Inc. (PMC). According to Shinto, emergency preparedness is a crucial aspect and vital consideration for insurers, not just care providers, because “payers support the providers, and if we’re not structurally sound, there could be some real consequences.” Shinto also adds that preparation for disaster is a sound business decision because of the moral obligation of first responders to provide healthcare. It’s also important because it is a business’ responsibility to take care of and protect its investments.

Dr. Shinto joined North American Medical Management (NAMM) in California in 1998 and laid the foundation for InnovaCare Health. At the time, he was a practicing physician, and he had noticed that there was an unmet need for operational expertise among physician groups and payers in a changing market. He worked with NAMM to help healthcare organizations provide quality care more efficiently. Select properties of NAMM were sold in 2012, and InnovaCare health was officially formed to operate the remaining subsidiaries, including MMM. InnovaCare has perpetuated its growth and expansion ever since, entering the Medicaid market and increasing revenues significantly.

Today, InnovaCare Health prides itself on providing a combination of innovation and quality care to create progressive, value-based models for even the most complex patient populations. According to its website, what sets the company apart is its “unmatched expertise,” along with “proven results,” and “industry-leading best practices.” Dr. Shinto is President and CEO and Penelope Kokkinides is InnovaCare’s Chief Administrative Officer.

InnovaCare was one of the first companies on site after Hurricane Maria struck Puerto Rico with 155 MPH winds and wreaked havoc on the island last fall, impacting more than 450,000 InnovaCare Health plan members and 2,000 of their employees.

Hurricane Maria formed on September 16 and dissipated on October 2 of 2017, and is viewed as the most destructive natural disaster on record to affect Puerto Rico. It’s also considered the most lethal Atlantic hurricane since Hurricane Jeanne in 2004. The storm killed nearly 3,000 people in Puerto Rico, making it the territory’s deadliest hurricane since San Ciriaco in 1899.

InnovaCare’s aid campaign was named Caminamos Juntos (“We Walk Together”) to ensure that everyone knew that they were not alone during the difficult time. “If you don’t have your employees, you can’t get your company up on its feet,” Shinto said, as he explained how InnovaCare provided assistance to staff who lost their homes. The company also built its own laundromats and barbershops in an attempt to restore some normalcy to life in the wake of the hurricane. InnovaCare’s disaster planning made sure that oversight from the disaster area and an unaffected location in New Jersey was provided by an emergency management team. Furthermore, a disaster recovery team and business recovery team were activated in order to ensure completion of essential functions in the community and the maintenance of key business operations, respectively. The business team was especially vital, as it made sure that the plan’s supply chain of providers – such as medical equipment and home health services – not only had continuity plans in place, but were also operational after the storm. The plan itself ensured that the provider network remained intact by making capitation payments to primary care providers and specialists in advance. It also made sure the staff could receive salaries after the storm passed by having cash on hand.

InnovaCare is a health plan that works across the entire healthcare ecosystem to increase availability of and access to high-quality, affordable care. The healthcare company focuses on creating and implementing innovative solutions for value-based healthcare with an integrated portfolio of health plans, medical service organizations, and clinical networks. InnovaCare is based in Fort Lee, New Jersey, and it has focused on population health management for more than a decade. The company has inspired patient and provider involvement by distributing risk and developing proprietary technologies. InnovaCare subsidiaries enable the enterprise to manage nearly half a million lives, including nearly 100,000 dual-eligible beneficiaries. The Centers for Medicare and Medicaid Services have given InnovaCare’s Medicare and Medicaid Advantage plans 4.5-star quality ratings. The plans have also received accreditation from the National Committee for Quality Assurance.

The damage in Puerto Rico is so severe that its effects still linger today. The roofs of Puerto Rican homes are still covered with blue tarps. Electricity is still not widely available. And yet, despite all the devastation that has afflicted Puerto Rico, its government is implementing major cuts to its health care safety net. This change will affect more than a million of its poorest residents. As required by the U.S. territory’s agreement with the federal government, it will have to come up with $840.2 million in yearly savings by the year 2023 to make a comeback from fiscal oblivion.

Overall, the territory’s large Medicaid expenses have led to Puerto Rico’s debt of more than $70 billion. To put that into context, the island’s yearly average household income is $20,000. Diabetes and hypertension are widespread. Add to that the fact that both health insurers and former government officials assert that the cuts result in severe deficits in care for the recovering population. Also, the cutbacks aren’t doing much to help the fiscal imbalance, and Puerto Rico’s health care problems mainly come from insufficient funds. The government already allocates much smaller amounts of the nation’s Medicaid budget to the territory compared to the other 50 states

These financial strains are clearly visible, as health plans have already begun laying off social workers and nurses. One of them is Eileen Calderon who has helped several chronically ill Puerto Ricans on a monthly basis by finding them specialists, supervising medicine compliance, and organizing rides to doctor appointments.

“These people who have been under our service for the last four or five years – all of a sudden I have to abandon them,” says Dr. José Joaquín Vargaspresident and chief medical adviser for VarMed, the Bayamon-based company that operated the program that employed Calderón.

Puerto Rico’s poverty is so widespread that almost half the residents qualify for public health insurance; in 2016, Medicaid expenses totaled $2.4 billion. With residents suffering from higher rates of chronic conditions like diabetes and asthma, as well as a quickly rising elderly population, the island’s fiscal health is doomed. However, some have suggested that the island’s debt would have been eliminated had it been receiving the same amount of Medicaid bills that Congress pays to the 50 states and Washington, D.C.

Many also assert that the health care system of Puerto Rico was experiencing a fiscal crisis even before Hurricane Maria struck. The federal government issued warnings announcing that the island would soon run out of additional Medicaid funds provided by the Affordable Care Act. As a result, nearly a million Puerto Rican residents would end up without coverage. As a means to address the potential crisis, Medicaid patients will have the option to choose from insurers, rather than being assigned one based on their ZIP code, a method the government hopes will force insurance companies to compete for individuals and, as such, offer better pricing. Dr. Shinto supports the government in its efforts, although he believes that it did not price things appropriately. “The oversight board is fixated on cuts,” he says, “but we’re never going to improve health care unless more money is put into the system.”

InnovaCare has reached thousands of Puerto Ricans with humanitarian aid via its involvement following the disaster. It did so in the form of providing meals and water, as well as entertainment and fellowship for adults and children. The company has also continued to offer medical services, including primary care consultations, diabetic testing and supplies, prescription refills, and mental health and social work services. Furthermore, InnovaCare/MMM partnered with the largest privately held spirits company in the world, Bacardi Limited, deploying caravans and bringing water, food, and medical services to 30 towns across Puerto Rico and helping thousands of individuals whose lives have been affected by the hurricane. InnovaCare also established a chronic care clinic, Vita Care, through which it set up free clinical tents where medical professionals provided immediate medical support. Overall, 200,000 residents were impacted and thousands of patients were treated, regardless of their insurance status.

Furthermore, InnovaCare raised more than $4 million through the Gwendolyn and Joseph Straus Charitable Fund for Puerto Rico Relief within a month of the Hurricane Maria landfall. Also, InnovaCare is grateful to all its stakeholders who have helped in their hurricane relief efforts. This includes physicians within the MMM network who volunteered their time and finances to help friends and neighbors. Along those lines, Daniel E. Straus, chairman of the InnovaCare Board of Directors, hosted the “Starry Night Masquerade” fundraiser in New York City, drawing nearly 1,000 attendees, including NFL players, recording artists, and actresses.

Within the first three weeks following the hurricane, the InnovaCare team delivered to the island more than 40,000 lbs. of medical supplies by means of chartered planes, which then evacuated the critically ill and their families. This ensured that these individuals received the treatment they needed. The employees themselves contributed by volunteering 8,000 hours.

InnovaCare’s leadership team has a combined amount of more than 120 years of experience in managed care and care delivery. The team is made up of professionals with expertise that can aid healthcare organizations, not only to meet but also surpass the growing demands of the industry in an effective manner. The firm leverages the collective administrative and operational expertise of its team so that its clients can be sure InnovaCare’s value-based model is taking into consideration every opportunity for improved quality, engagement, and margins. Overall, InnovaCare believes in smarter healthcare delivered by engaged, dedicated, and tenacious physicians.

The latest addition to Innovacare’s leadership board is Ms. Penelope Kokkinides, the company’s Chief Administrative Officer. She brings to InnovaCare more than two decades of experience in healthcare, with a special focus in government programs (Medicare and Medicaid) and the managed care industry. Her background also brings to the table extensive knowledge and expertise in clinical programs development and health care processes and operations management, with a focus on enhancing efficiencies and organizational infrastructure.

Prior to joining InnovaCare, Kokkinides has held several executive roles, including Executive Vice President and Chief Operating Officer for Centerlight HealthCare, where she was responsible for overall management and strategic direction of the managed care division; Chief Operating Officer of Touchstone Health; and Corporate Vice President for Care Management and Disease Management at AmeriChoice, a business unit of UnitedHealth Group, where she was instrumental in developing and implementing the company’s health model. Ms. Kokkinides received her B.S. in biological sciences and classical languages from Binghamton University, and completed her M.S. in Social Work from New York University. She also earned a second Masters in Public Health from Columbia University.

InnovaCare Health Solutions, LLC’s President and Chief Executive Officer Dr. Shinto is also Chief Executive Officer at MMM Healthcare, Inc., and has more than two decades of clinical and operational healthcare experience in managed care. Dr. Shinto began his medical tenure as an internist and pulmonologist in Southern California. He served as Chief Executive Officer at Aveta Inc., Chief Executive Officer at MMM Healthcare, Inc., and Chief Executive Officer at PMC Medicare Choice, Inc. He also served as the President and Chief Executive Officer of Aveta Inc. and North American Medical Management of Illinois, Inc., where he was also a member of the management team. Dr. Shinto served as Chief Medical Officer of NAMM California. Prior to joining NAMM, he was the Chief Operating Officer and Chief Medical Officer for Medical Pathways Management Company. After serving as the Corporate Vice President of Medical Management for MedPartners from 1996-1997, he left to become the Chief Medical Officer for Cal Optima Health Plan in Orange County, California. Dr. Shinto received his B.S. from the University of California at Irvine, his medical degree from the State University of New York at Stony Brook, and an M.B.A. from the University of Redlands.

In terms of the situation in Puerto Rico, it is unlikely that managed-care companies will employ the social workers and nurses needed to travel the territory in order to address the daily problems of poverty. At a time when the government is pushing to cut any additional expenses, these individuals are not a priority.

Add to that the fact that all the people who have been relocated have not been able to return to their homes yet, which makes healthcare delivery even more difficult. According to Carmen Ramos, executive director of Redes del Sureste, a conglomerate of 22 medical groups in Puerto Rico, nearly 60 percent of the letters she recently sent to patients on her mailing list were returned. “The managed-care companies need to produce revenue,” says Victoria Sale, a senior director at Camden Coalition, a pioneer of social and health programs for the chronically ill.

The already financially strained territory must make decisions that will further affect the health of its citizens at a time when these circumstances have forced Puerto Rico to cut healthcare collaborations. InnovaCare, under the leadership of Rick Shinto and Penelope Kokkinides, not only remains actively involved in the healthcare of the territory, but has intensified its involvement in the territory following one of the largest natural disasters that Puerto Rico has ever seen. Shinto is prepared, as his plan is to “hope for the best, but plan for the worst.” The experience before, during, and after Maria helped Shinto realize that time is of the essence when responding to a disaster. A rapid response is only possible if there is sufficient planning beforehand. “By showing that aggressive response, it shows commitment to the employees, to the providers, and to the community,” he concluded. “The return on that is really worth the investment, instead of always thinking about the dollars.”

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