Puerto Rico Gov Pleads for Medicare Advantage Funding

Gov. Wanda Vázquez (Juan J. Rodríguez/CB)

Urges U.S. Health Secretary, CMS Administrators to Treat Island Equally

SAN JUAN — Concerned about the island’s Medicare Advantage (MA) program, Puerto Rico Gov. Wanda Vázquez Garced sent a letter to Alex Azar II, the secretary of the U.S. Department of Health and Human Services (HHS); Seema Verma, the administrator of the Centers for Medicare & Medicaid Services (CMS); and Demetrios Kouzoukas, the principal deputy administrator and director of CMS.

She urged them to “identify ways to restore more equitable funding”—as phrased in a press release by the Puerto Rico Federal Affairs Administration (PRFAA)—for the Medicare Advantage (MA) program on the island for fiscal year 2021.

The program serves more than 585,000 seniors in Puerto Rico. The letter outlined several priorities of the government to address some of the short-term healthcare challenges facing the elderly population on the island.

In the letter, the government proposes changes to MA funding and urges CMS to use the period before the release of the Final Call Letter to “identify ways to restore a more equitable 2021 funding for Puerto Rico’s  MA program.”

The letter stressed that the island’s current payment rate stands at 42 percent below the U.S. national average, “below Hawaii (the lowest state in the nation) and the U.S. Virgin Islands,” the PRFAA added.

More than 40 percent of Puerto Rico’s residents, the PRFAA said in the announcing release, live below the poverty line, and the island has the highest participation of MA beneficiaries in the United States, at approximately 75 percent.

Additionally, 280,000 beneficiaries in Puerto Rico are “dually eligible” for Medicare and Medicaid, the PRFAA said. “However, the MA program in Puerto Rico has the lowest payment rate by far in the entire program and beneficiaries do not receive the same Part D Low-Income subsidies as citizens in the rest of the United States. Using the period prior to the release of the Final Call Letter would present an opportunity to help improve Puerto Rico’s healthcare system,” the agency assured.

“We urge Secretary Azar, Administrator Verma, and Deputy Administrator Kouzoukas to use this period prior to the release of the Final Call Letter to identify ways to make Puerto Rico’s Medicare Advantage Program more equitable. This would address in the short-term, several challenges of our healthcare system,” PRFAA Executive Director Jennifer M. Storipan said. “I believe our most senior citizens must have access to much-needed quality healthcare. We must take action to ensure the welfare of our seniors.”




Puerto Rico governor focused on federal funds, restructuring process

Gov. Wanda Vázquez (Juan J. Rodríguez/CB)

During convention speech, stresses need for commonwealth gov’t to regain Washington’s trust

SAN JUAN — Nearly a month before Puerto Rico’s Medicaid funding ratio reverts back to pre-Hurricane Maria levels, Gov. Wanda Vázquez Garced assured that her administration was focused on improving the island’s reputation, which has been tarnished in the eyes of Congress and federal agencies, with the goal of receiving more Medicaid and Medicare funding.

Vázquez made the related remarks during her speech at the Puerto Rico Hospital Association’s annual convention, where she also underscored the island’s debt restructuring process and the relationship between her administration and the federally created Financial Oversight and Management Board.

“It is true that we have been in constant communication with the [fiscal] board about the debt adjustment plan of the commonwealth, and we are satisfied with the process so far. We also continue to work in a collaborative way, defending, always, the interests of our people, while at the same time we find alternatives and recommendations to comply with our obligations in a reasonable and effective way,” Vázquez said. 

The governor has come under scrutiny for not opposing strongly the pension cuts included in the commonwealth’s debt adjustment plan. Also, sectors such as the workers union for the Puerto Rico Electric Power Authority have urged her to not approve any laws that make way to the cuts or the electric bill charge included in the utility’s debt restructuring agreement.

While Vázquez said her administration has “a good relationship with the board and that is something that wasn’t there,” she also acknowledged there are disagreements but said there was no need to have public spats. 

The governor used as an analogy a person taking out a loan and the bank deserving repayment to argue that Puerto Rico must service its debt, which totals some $72 billion, adding that she can think of a better course of action to address the liabilities because she doesn’t have to think about losing votes, as she has vowed to not run in the 2020 elections. 

One of the reasons the governor gave to not dismiss the island’s debt is to not harm Puerto Rico’s credibility, which she stressed was one of the main reasons the administration of President Trump is reluctant to provide more federal funds. She said that in her recent visit to Washington, D.C.—in part to lobby for an extension to the temporary 100 percent Medicaid matching rate—the issue of corruption often came up, especially in light of the arrests in July of the former head and contractors of the Health Insurance Administration, which manages the island’s Medicaid funds through the government’s Vital healthcare program. 

The governor recalled that during her tenure as Justice secretary, the government implemented the Medicaid Fraud Control Unit, a joint project between the Health and Justice departments. 

Although only mentioned once during her address, unlike the credibility issues, Vázquez posited that the disparity in federal healthcare funding is related to Puerto Rico’s political status as an unincorporated territory. The governor stressed that the argument needs to be that Puerto Ricans deserve the same treatment residents of the 50 states. 




Legislation introduced to expand Medicare Part D low-income subsidies to U.S. territories

The U.S. Capitol in Washington, D.C. (File)

Bipartisan bill would allow residents of Puerto Rico, other U.S. territories to become eligible for the subsidy program beginning in plan year 2021

SAN JUAN — Reps. Donna Shalala (FL-27), Darren Soto (FL-9), Jenniffer González-Colon (PR), and Stephanie Murphy (FL-7) introduced Wednesday the Medicare Low-Income Subsidy Expansion for Territories Act of 2019, bipartisan legislation that would allow residents of U.S. territories to become eligible for the Medicare Part D low-income subsidy (LIS) program beginning in plan year 2021.

The LIS program (also called Extra Help) assists low-income individuals by providing subsidies to fully or partially cover their out-of-pocket costs under the Medicare Part D prescription drug program. Program subsidies help reduce or completely cover the out-of-pocket cost of Medicare Part D premiums, deductibles and coinsurance, while also eliminating the prescription drug coverage gap and waiving the penalty for late enrollment into Medicare Part D.

Residents of U.S territories are currently barred from receiving LIS under Part D. In place of the low-income subsidy, territorial residents receive a fixed amount of funding to provide Medicaid-covered prescription drugs for all low-income beneficiaries. This funding can be substantially lower than the amount of federal financial support that low-income beneficiaries would receive if territorial residents were eligible for the LIS program.

“For generations, the residents of Puerto Rico and other U.S. territories have been treated like second-class citizens,” Shalala said in a joint release. “Though these territories face many inequities, poverty–particularly among seniors–may be their most daunting challenge to overcome. This bill is an important step towards alleviating poverty among seniors in Puerto Rico and other territories with aging populations, and it is also a meaningful stride towards better and more equitable treatment for American citizens who have for too long been ignored.”

“This is a step forward for Puerto Rico and the rest of the U.S. territories that have suffered from unequal treatment in several Medicare programs,” said González-Colón. “In the specific case of Puerto Rico, the current situation is critical for the elderly because of limited access to prescription drug assistance compared to the citizens of the rest of the states. H.R. 4666 would grant our duals the same right to access to Medicare Part D subsidies that other Americans enjoy. It is a step in correcting the discrimination in federal programs that our most vulnerable citizens suffer, for the only reason of wishing to remain in Puerto Rico.  I want to thank my colleagues in Congress for supporting such an important piece of legislation that will improve the quality of life of the 3.2 million American citizens that live in Puerto Rico.”

No senior should ever have to forego vital, life-saving healthcare just because of where they live,” said Soto. “At a time when Puerto Rico and the U.S. territories are still suffering from the long-standing injustice of poverty, it’s more imperative than ever that we ensure our communities get the care they deserve. I’m proud to introduce H.R. 4666 with my colleagues and I’m grateful for the bipartisan support.”

“Puerto Rico and the other U.S. territories deserve to be treated fairly. I’m proud to support this bipartisan bill that ensures low-income seniors in Puerto Rico receive the same assistance as their fellow Americans in Florida and other states to help them better afford their prescription drugs,” said Murphy, a member of the House Ways and Means Committee.

González Colón and Soto had also previously introduced HR 4195, Territories Medicare Prescription Drug Assistance Equality Act of 2019, a bipartisan measure that would make the Part D LIS Program applicable in the territories in the same way as is applicable stateside, to continue driving that this assistance be granted to U.S citizens residing in Puerto Rico.




Puerto Rico gov discusses recovery aid with federal officials in Washington

(Courtesy)

Week-long agenda also focuses on improving credibility in Congress

SAN JUAN — Puerto Rico Gov. Wanda Vázquez continued her meeting agenda in Washington, D.C., Tuesday in an effort to regain the federal government’s trust in the island’s government administration and achieve the disbursement of funds for Medicaid, economic development, housing and reconstruction after Hurricane Maria, among other pressing needs of the island.

In a statement issued by her office, La Fortaleza, the governor noted that she would be meeting with White House Office of Intergovernmental Affairs officials to discuss Puerto Rico’s recovery efforts and the allocation of federal funds.

Vázquez will meet with Treasury Secretary Steven Mnuchin and Housing Secretary Ben Carson. In addition, she will meet with Energy Department officials.

Resident Commissioner Jenniffer González and Puerto Rico Federal Affairs Administration (PRFAA) Executive Director Jennifer Storipan will accompany the governor for some of the meetings.

Vázquez arrived in Washington on Sunday and started to hold meetings Monday, when she discussed the island’s funding and health-related program needs with officials from the U.S. Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Service. She also met with Education Assistant Secretary Frank Brogan, with whom she discussed priority issues “for the proper functioning of Puerto Rico’s school system.”

The governor will meet with members of the Federal Emergency Management Agency (FEMA) on Thursday regarding the island’s recovery efforts after hurricanes Irma and Maria. 

“The main purpose of this visit to the federal capital is to restore relations with federal entities that are key in the disbursement of funds for the recovery of Puerto Rico and the projects that allow the social and economic development of the island,” Vázquez said in a statement. “We are focused on improving the credibility of Puerto Rico at federal Congress, as well as creating alliances to develop projects that improve the quality of life of Puerto Ricans.”

On Wednesday and Thursday, Vázquez and Puerto Rico officials will meet with various members of Congress to continue discussing hurricane recovery efforts, Puerto Rico’s admission as a state, the Puerto Rico Oversight, Management & Economic Stability Act (Promesa), the energy system and Medicaid. 

The meetings slated for Wednesday and Thursday include separate conversations with Reps. José Serrano (D-N.Y.), Darren Soto (D-Fla.), Nydia Velázquez (D-N.Y.),  Rob Bishop (R-Utah), Stephanie Murphy (D-Fla.), Greg Walden (R-Ore.), Rick Scott (R-Fla.) and Lisa Murkowski (R-Ark.), according to an agenda sent to Caribbean Business. 




V2A report: Difficult times for Puerto Rico hospital sector

‘Consolidation, both across the hospital sector but also vertically along the health system may help turn these trends around.’

Editor’s note: The following was published in the most recent newsletter issued by Vision to Action (V2A), a strategic consultancy firm that also analyzes industries and has been publishing its reports since 2009.

Hospitals play a key role in the provision of health services to Puerto Rico citizens. In recent years they have been operating in a complicated environment where several industry trends have been hurting their profitability. That situation has only been aggravated by Hurricane María. Consolidation, both across the hospital sector but also vertically along the health system may help turn these trends around.

This article is the first of a series of Insights where we evaluate the hospital sector of Puerto Rico, looking at its recent trends and providing our perspective looking forward. Let’s start with the size of the hospital sector. There are 61 community hospitals1 in Puerto Rico with a total of approximately 9,350 inpatient beds with presence in 24 of the 78 Municipalities (see Figure 1, double click to zoom in and browse the map to see hospital names and number of beds by hospital)2. The MetroPavía system is the largest hospital group with 11 hospitals across Puerto Rico and 15% of all inpatient beds in the Island, followed by HIMA with 5 hospitals and 13% of inpatient beds (mainly in the Metro and East regions) and the Doctors group with 4 hospitals and 7% of inpatient beds.

The hospital sector in Puerto Rico has experienced a deterioration in terms of profitability driven, in part, by the impact of Hurricane María but, also, by industry dynamics that are putting pressure on their margins. As can be observed in Figure 2, the number of hospitals with a negative income margin increased from 15 to 25 in the past five years, representing almost 44% of all the community hospitals in 2017-18. This compares unfavorably against the hospital sector in the US where the proportion of negative income hospitals averaged 23.5% during the 2010-16 period (22.6% in 2015 and 26.4% in 2016).

One of the forces driving the lower profitability is the effort made by Medicare, Medicaid and the health insurers to reduce hospitals costs. In part, this is done by working with doctors and hospitals to reduce the number of patients that are hospitalized and the average length of stay in hospital inpatient beds, obviously ensuring that patients can be safely treated outside hospitals. This has long been the trend in the United States where the percentage of inpatient vs outpatient revenue decreased from 70% in 1995 to 63% in 2005 and 52% in 2016 (see Figure 3). As can be observed in Figure 4, the Puerto Rico hospital sector has also experienced this trend in recent years (from 68% in 2014 to 64% in 2018) but the proportion of inpatient revenue is still significantly above US levels. The higher inpatient revenue levels in Puerto Rico compared to the United States indicates that there is room for further reduction in terms of patient hospitalization and average length of stay in hospitals. We should expect further margin pressure for hospitals from the inpatient revenue side.

There seems to be an excess of hospital beds in Puerto Rico which is also impacting hospital financials. Puerto Rico ranks number 18 in terms of number of beds per 1,000 persons when we compare against States in the US (see Figure 5). The 2.89 number of beds per 1,000 persons is high, particularly when we consider that the Island is quite dense in terms of population compared to most States. In other words, there is not a need to subsidize hospitals in remote areas with low population density as in States like, for example, Nebraska or Montana. In fact, highly dense States like New Jersey, Rhode Island or Massachusetts show significantly lower ratios than Puerto Rico (2.33, 2.12 and 2.30, respectively).

If we draw a straight line from the center of each of the 901 Puerto Rico sub-counties (“barrios”) to the nearest community hospital, we will only find 19 sub-counties with a straight-line distance larger than 20km. One of these sub-counties is Isla de Mona and another 7 sub-counties are located in Vieques where the only community hospital closed after María and has not reopened since. For the other 11 sub-counties, the straight-line distance to the nearest hospital ranges between 20 and 22.5 kms and they are located in Santa Isabel (Jauca 1), Orocovis (Damián Abajo, Cacaos, Collores, Damián Arriba and Pellejas), Quebradillas (Guajataca, Terranova, San Antonio and Quebradillas Pueblo) and San Sebastián (Guajataca).

The large number of hospital beds is also confirmed by the fact that bed utilization is, in general, low in Puerto Rico. A total of 25 community hospitals in Puerto Rico have a utilization rate below 60%. As can be observed in Figure 6, most of the hospitals with low utilization rate also charge less per inpatient discharge. There seems to be a large variability in terms of the amount charged by hospitals across Puerto Rico. This variability is not only driven by the mix of service types provided by hospitals (e.g. cardiovascular surgeries are more expensive than orthopedic surgeries) but also by a large variability in operating costs across hospitals.

But what are the implications of the deterioration of hospitals profitability and the drivers behind it? First of all, there seems to be room for consolidation to leverage hospital synergies, particularly for hospitals located in the same region or adjacent regions. For example, instead of competing against each other for the same patients, hospitals in the same region under a common administration could become complementary through focusing in differing specializations. Additionally, patients could be “directed” to the hospitals with lower utilization and/or more affordable prices (not necessarily with lower margins). Consolidation, particularly within regions, also allows for the integration of information systems (including patients records), better communication between doctors and the standardization of processes, translating into a better and more efficient service to the patient.

Another trend that we should expect to continue is vertical consolidation, where insurance companies enter the business of providing health care services, in this case through the acquisition of hospitals. That move allows insurance companies to align their incentives (reduce unnecessary healthcare costs) to those of the hospitals. Additionally, they increase the number of touchpoints with their affiliates to convey healthy practices and focus on prevention.

There are plenty of hospitals that could be targeted by existing groups or health insurance companies. A total of 20 non-government hospitals in Puerto Rico (33% of total) with 28% of total inpatient beds do not belong to any hospital group. There are 13 more that belong to hospital groups of less than 4 hospitals and they accumulate 23% of total inpatient beds. In other words, there is space in the hospital sector for more concentration.

Finally, there is another trend in the United States and Puerto Rico hospital sectors that may put more pressure on revenue margins. That is the increased focus on quality by CMS and other Federal regulators. Based on the available data provided by CMS for Medicare patients, Puerto Rico does not fare well in terms of the quality of services provided by hospitals vis-à-vis hospitals in the United States. In the next insight of this series dedicated to the hospital sector in Puerto Rico we will take a close look at the quality metrics available for hospitals in the Island.

Notes:

1Based on the American Hospital Association (AHA), community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; long term acute-care; rehabilitation; orthopedic; and other individually described specialty services. Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries.

2Data for hospital in Culebra not available

Sources:

American Hospital Directory (https://www.ahd.com/); American Hospital Association “Trendwatch Chartbook 2018”

Disclaimer

Accuracy and Currency of Information: Information throughout this “Insight” is obtained from sources which we believe are reliable, but we do not warrant or guarantee the timeliness or accuracy of this information. While the information is considered to be true and correct at the date of publication, changes in circumstances after the time of publication may impact the accuracy of the information. The information may change without notice and V2A is not in any way liable for the accuracy of any information printed and stored, or in any way interpreted and used by a user.

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MCS develops app to optimize healthcare operations

(Courtesy)

Rx Pharmacy helps improve service to Medicare members

SAN JUAN — Puerto Rico managed healthcare plan provider MCS has launched Rx Pharmacy, an application to allow the more than 1,000 pharmacies in its network to process prescription drug pre-authorizations through an online system.

The objective of adopting the new technology is to replace the manual process, “thus facilitating members’ access to the prescription drugs they need,” MCS said in a release, adding that as an added-value, the tool fosters “teamwork with the pharmacies to optimize business operations and streamline the services provided” by MCS Advantage to MCS Classicare members.

Pharmacies belonging to the MCS network first register at a central portal—provinet.mcs.com.pr—to be able to begin offering the streamlined service.

“At MCS, we are pioneers in implementing this virtual system, which will improve communications between the pharmacies and the medical plan, while reducing medication pre-authorization wait times. For example, for expedited medications, we expect to reduce the pre-authorization time from 24 hours to an average of just 12 hours. And for standard 72-hour medications, an average of 36 hours. That way, we can ensure our members keep their health conditions under control,” Dr. Carolyn Rodríguez, executive vice president of Pharmacy at MCS, said in the published announcement.

Rodríguez explained that the industry conducts the pre-authorization process by fax, an antiquated and cumbersome process.

“However, with Rx Pharmacy, we will be able to streamline the prescription drug pre-authorization process, which will help prevent duplicate faxes, reduce hardcopy expenses, and provide the real-time status of each case. It will also result in a virtual database, allowing the pharmacy and the member to be quickly informed of the pre-authorization status of a much-needed medication,” she said.

MCS’s CEO, Jim O’Drobinak, added that the move is a reflection of the company’s commitment to ensure that its provider network offers the best services possible.

“In order to provide quality health care, it must be based on automated processes that speed up the operation of the business. Only then can better service be provided to our members. That’s why it’s essential that providers incorporate the necessary technological solutions into their operations. And because we are aware of this, we used our in-house talent to develop and implement the Rx Pharmacy application, which will allow us to work as a team with our pharmacies to further improve the health care we currently offer to our members,” O’Drobinak said.

At the Puerto Rico Pharmacists Convention, which will be held Aug. 15-16, MCS will deliver an educational talk on pre-authorizations and Rx Pharmacy’s features, including its ability to generate reports for business operations. The talk will be worth three continuing education credits.




Puerto Rico governor to attend State of the Union

SAN JUAN – Puerto Rico Gov. Ricardo Rosselló was invited by Senate Democratic leader Charles Schumer of New York to attend President Trump’s State of the Union address.

Rosselló left Monday evening for Washington for the event Tuesday at the House of Representatives. His office, La Fortaleza, said he also intends to meet with members of Congress and the Trump administration to “discuss pressing matters pertaining the approval of emergency aid to meet the funding of several assistance programs of the Island.”

The referred to federal aid includes that for the island’s Nutritional Assistance Program and Medicare and Medicaid funding, “as well as other issues related to the recovery and reconstruction of Puerto Rico following the passage of Hurricane Maria in 2017.”

A spokesman for Rosselló said the governor plans to “warn Trump against ‘draining’ cash earmarked for post-hurricane recovery efforts on the island and use it to fund the construction of a border wall with Mexico,” according to the New York Daily News.

Rosselló will be joined by the executive director of the Puerto Rico Federal Affairs Administration, Carlos Mercader, for the meetings.

Puerto Rico Secretary of State Luis Rivera will serve as acting governor until Rosselló returns to the island Thursday.

Puerto Rico gov says he asked Trump if he would use recovery funds for border wall




Prima Bill Gains Important Support

Grover G. Norquist, president of Americans for Tax Reform, joined the request by the Government of Puerto Rico and Financial Oversight & Management Board (FOMB) requesting Congress to approve H.R. 6809, the P.R. Integrity in Medicare Advantage Act (Prima), which was presented by the island’s Resident Commissioner Jenniffer González Colón.

Americans for Tax Reform is a nationally known anti-tax advocate organization that Norquist founded. His support is important because this group is a strong ally of several Republican members of Congress and President Donald Trump.

In the letter to members of Congress, Norquist said the legislation “has bipartisan support in the House of Representatives,” and legislators “should ensure the Prima Act is passed into law before the end of the year, either as a standalone bill or in a broader vehicle.”

Grover G. Norquist, president of Americans for Tax Reform. (Gage Skidmore)

Prima was introduced by Resident Commissioner González Colón and seeks to establish a 0.70 average geographic adjustment (AGA) baseline for each county in the United States. The AGA changes reimbursement based on estimated operating expenses in different regions across the country.
“The Prima Act provides a temporary, modest, deficit-neutral correction to Puerto Rico’s Medicare Advantage [MA] base payments level that will help the island recover from the catastrophic negative impacts of the hurricanes,” Norquist said in his letter.

“Compared to traditional Medicare coverage, [MA] plans leverage competition to promote consumer choice, increase options and put downward pressure on costs. The Trump administration is rightly expanding on this model to promote further private-sector negotiation and efficiency,” Norquist added. “Utilization of [MA] plans in Puerto Rico are high compared to many U.S. states. Today, there are roughly 580,000 seniors in Puerto Rico covered through [MA] plans, or nearly 90 percent of those eligible for Medicare,” Norquist pointed out.

In Puerto Rico, Medicare Advantage payment rates were 24 percent lower than the U.S. average in 2011 and have fallen for the past seven years. In 2019, the average base payment will be 43 percent lower than the U.S. average.

The intention of the legislation is to address this discrepancy “by increasing Puerto Rico’s average geographic adjustment, which is set by the Centers for Medicare & Medicaid Services to 0.70 for 2019, 2020 and 2021.”

“Over 97 percent of the counties currently have AGA factors of between 0.70 and 1.3, so this is a modest change that will bring Puerto Rico more in line with the mainland United States,” the activist said.
On similar terms, Natalie Jaresko, executive director of the FOMB, last week wrote to the U.S. congressional leadership requesting they address the disparity between the island and other stateside jurisdictions regarding healthcare funding.

Her letter stressed that the situation “affects the viability of doctors and service providers for Medicare beneficiaries to continue working in Puerto Rico, further exacerbating the exodus of physicians.”

“This increase would have a significant impact on Puerto Rico’s private health sector. The bill establishes a three-year sunset [automatic termination unless it is reauthorized] on this increase, sufficient to counterbalance the long-term effects of the devastation caused by the [2017] hurricanes,” Jaresko, wrote.

The letter was addressed to Senate Majority Leader Mitchell McConnell Jr., House Speaker Paul Ryan Jr., Senate Minority Leader Charles Schumer and House Minority Leader Nancy Pelosi.




MCS renews multimillion-dollar contract with PharmPix 

SAN JUAN – Puerto Rico health insurance provider Medical Card System Inc. (MCS) announced Wednesday that it has entered a contract renewal agreement with Puerto Rican-owned PharmPix Corp. for the latter to manage the pharmacy benefits of MCS’s more than 180,000 commercial customers, “covering over $150 million in annual drug spending.”

Among the initiatives MCS and Guaynabo-based PharmPix have developed since partnering in 2016, are the MCS Life’s Prescribed Drugs by Mail program, which allows members to receive their medications at home; the Concurrent Drug Utilization Review (DUR) program, which verifies a patient’s drug history to identify potentially harmful or unsafe combinations of prescription medications; and Quality Clinical Projects aimed at educating members with diabetes and therapy adherence problems.

MCS CEO Jim O’Drobinak said that in addition to its commitment to Puerto Rico residents’ healthcare, the insurer’s relationship with PharmPix reflects its dedication to support the island’s economic well-being.

“In these historic times that Puerto Rico is experiencing, we at MCS are committed to promote talented Puerto Rican-owned companies that can ensure the continued improvement of both Puerto Rico’s financial health and the healthcare experience of our members,” O’Drobinak said. “Given that healthcare is one of our Vívela MCS corporate culture pillars, which embrace our MCS Conexión de Salud program, we have decided to extend our relationship with PharmPix since they have proven to be an outstanding business partner ensuring the proper delivery of pharmacy benefits. PharmPix has exceeded its pharmacy benefit manager role by assisting us in the development of innovative programs intended to help improve our members’ health in many creative ways.”

MCS also provides various Medicare Advantage plans under a contract with the Ccenters for Medicare and Medicaid services. MCS Life Insurance Co., meanwhile, offers commercial health plans for groups and individuals, as well as group life insurance. MCS General Insurance Agency offers life and disability products.

“At PharmPix, we are focused on providing effective support to our clients’ clinical operations in favor of the patients who benefit from our services. We maintain the transparency that allows trust and security in our work, and this puts us in the position of having again the support of companies such as MCS,” said Dr. Martty Martinez Fraticelli, PharmPix’s president and chief pharmacy officer, who oversees more than 100 employees.




Humana launches community outreach, senior programs campaign

SAN JUAN – With a multimillion-dollar investment, Humana has launched a publicity campaign and community outreach programs aimed seniors. Under the “Vamos hay mucho por vivir!” or “Come on, There’s a lot to Experience!” slogan, the health insurer hopes to promote the achievement of new goals and projects while staying healthy.

The campaign includes events such as “Humana en tu Pueblo,” or “Humana in Your Town,” to be held across the island’s municipalities with renowned entertainers Luisito Vigoreaux and Noelia Crespo and their comedy show. In addition, as part of the effort, a “Humana University” course program will be offered at educational institutions to help the population adapt to technological advances.

“We want to encourage optimism while helping them with the variety of product options we have from Medicare Advantage plans to maintain optimal health. We see a large number of seniors who are alone or who have made the decision to stay in Puerto Rico while their family members emigrated to the United States.

“Many of them are looking for ways to have fun while making new friends. Given the [island’s] economic situation, we designed an offer that provides financial aid through our products,” said Luis A. Torres, president of Humana in Puerto Rico.

The production, made with local talent, put together everyday scenes of elderly people spending time with friends, going on a trip or having fun with grandchildren and relatives.

The company’s director of marketing and public relations, Sandra Estada, said the creative concept and its foundation were inspired from observing how seniors look for ways to achieve goals while valuing family relationships and friendships.

Humana has Medicare Advantage plans for coordinated care for people with dual Platinum and non-Platinum eligibility, Medication Plans and Supplemental Medicare coverage. Some of these, without referrals and Platinum products with reduced Medicare Part B premiums that start at $35 monthly, up to $85, among other benefits.