Throughout the COVID-19 pandemic, InnovaCare Health, which operates Medicare Advantage and Medicaid plans in Puerto Rico—as well as in Florida—has been working closely with providers and government leaders to address the virus’ spread, including doing home delivery of everything from medicines to food for its members in the territory. CEO Dr. Richard Shinto spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: What’s the state of play in Puerto Rico right now?
Shinto: I think the government did a very good job during the first few months of the pandemic. They closed down the island. No ships were allowed to come in. Tourism was stopped. The reason they did that was they don’t have a deep enough healthcare system to have ventilators and all the necessary means to protect all the residents of the island.
So the governor mandated across-the-board curfews and shut everything down. They did a very good job of really suppressing the infection.
Our numbers are very low. I think maybe we broke close to 400 deaths total. There’s maybe 24,000 positive cases right now. The last numbers I saw, (there were) about 400 people in the hospital. Really, that’s more of a (recent) surge. It was even lower than that, but when everything started to open up, especially bars, all of a sudden there was another surge.
Currently, the stay-at-home policy is a curfew from 10 at night until five in the morning. No alcohol (sold) after 7 p.m. On Sundays, everybody has to stay indoors unless it’s just for grocery shopping or going to the pharmacy. Again, the government is putting a lot of pressure on everybody and the difference between Puerto Rico and a lot of other places (in the U.S.), they actually do implement it and they actually do fine you. The fines can be up to $500 if you’re not wearing a mask and you wander around the streets in Puerto Rico.
MH: Can you talk about your experience working with the government in Puerto Rico versus in Florida?
Shinto: One of the things Puerto Rico has done a very good job of is creating alignment. There’s alignment between the health plans, the providers, the hospitals and the government. So when we go to D.C. or we speak on behalf of the island, it’s usually one voice.
MH: Working with providers, you advanced payments to doctors and hospitals in the early stages of the pandemic. That’s continuing, right?
Shinto: Yes. To date we’ve paid out somewhere over $160 million of advance payments to providers, both hospitals and physicians. Many of our specialists are on fee-for-service, so we did quick calculations on what our average pay to them was. From that, we were able to advance pay them.
It’s interesting about disasters and the number of them that hit the island. We learned this after Hurricane Maria—the physicians needed the income and they’re not going to be able to submit encounter data.
On the pandemic, we advance paid the doctors before we shut down the offices. We knew they needed income so they could continue to take care of the beneficiaries and members.
MH: Can you talk about the work you’re doing with at-home delivery of medications and over-the-counter supplies?
Shinto: As you practice in the States, you think about mail order and you think about chain pharmacies. That doesn’t really work here. So over the years, we got into home delivery. We do home delivery for almost everything—your pharmacy, all your over-the-counter (supplies). Even prior to the pandemic, we were already starting home delivery of food.
Puerto Rico is a great testing ground. When people started to get all their medications, all their (personal protective equipment)—if they wanted masks or they needed antiseptics for their hands—they just (place an order) on the website and it gets delivered within 48 hours. Then we started delivering food and then people didn’t want it pre-cooked. They wanted to make their own. Then we started offering groceries, so you can go onto our sites and get whatever you need.
We’ve built it into our benefit design so that members can get an iPhone, because then the app is already loaded—allowing them to order all their over-the-counter (supplies) or if it’s connected into the pharmacy, they can get home delivery there as well. We believe the future of healthcare has to be in that space of delivery.
MH: What challenges have you had, if any, building up a supply chain?
Shinto: One thing we learned after (natural) disasters is you’ve got to be ahead of the supply chain. I remember all the water we had ordered after (Hurricane Maria) and the generators, but FEMA came in and took control and it bothered us that we had a great supply chain. We had pre-ordered a lot, but then the (U.S.) government comes and takes over.
When COVID came, we again preplanned and we went to the supply chain. We were able to move 3,500 employees out of the offices, into their homes, in less than a week. We had a lot of supplies like computers and modems for people who needed it. We did a great job on pre-ordering PPE and COVID testing. But again, the (U.S.) government came in and confiscated everything. Then, we had to struggle to get the masks, or we had to go to China. So that created some problems. Even today, because of the limited amount of reagent on the island, the Puerto Rican government has taken control of testing.
MH: So PPE was taken from the island and brought back to the mainland?
Shinto: It wasn’t allowed to ship to the island. Even the COVID testing, which we had pre-bought. Being a physician and thinking about looking ahead … we needed to have, masks, gowns and gloves. We went after those and then the testing and we were able to buy a lot of testing, but then they would get stopped at the ports. The government would take over in the States and then redirect it someplace else.