Manny Sanchez, left, COO, and Orlando Gonzalez, president of MMM, a Medicare Advantage and managed Medicaid insurer in Puerto Rico, talk at AHIP about the devastation of Hurricane Maria.
SAN DIEGO - Nine months after Hurricane Maria devastated the U.S. territory of Puerto Rico, the heads of one of the island's largest Medicare Advantage and managed Medicaid insurers sat down to talk about how they dealt with the crisis and where things stand today.
Insurance company MMM, which stands for Medicare and Much More, was on the frontlines of disaster recovery when Hurricane Maria swept across Puerto Rico last September and sustained 150 mph winds downed trees, made roads impassable and knocked out power and communications.
Before the hurricane, most residents had water, a telephone and electricity, said Manny Sanchez, COO of MMM, a company owned by InnovaCare Health Solutions in New Jersey.
Hurricane Maria was like a tornado that was 50 miles wide, Sanchez said. The last time the island had seen anything like it was in 1928.
Ninety-six percent of the island now has electricity, about the same number who had power before Maria, he said.
The news that came out directly after the storm reported horror stories of needed supplies sitting on ships waiting for trucks and drivers, residents living in the hilly interior of the island who could not be reached, and patients with chronic care conditions who could not get out for care.
Even today, the number of deaths from the hurricane is in dispute, with numbers reported from 64 to 2,000 and some putting that figure much higher.
"The first week it was like MASH," Sanchez said.
MMM set up a makeshift grocery store where food was free, established a laundry and gave out generators.
Because the banking system was down and debit cards would not work, the insurer handed out cash to its employees.
The cost to the insurer ran into several million dollars.
Even before the hurricane, MMM leased as a floor in one of the island's three major hospitals to have representatives on hand to help patients transition to care after discharge, make follow up appointments and make sure that prescribed drugs are hand- delivered to the patients' rooms.
"The social determinants of care are critical," said Orlando Gonzalez, president of MMM.
About 42 to 43 percent of residents live in the federal poverty level and a high number are covered by Medicare and Medicaid. In fact, Puerto Rico has the highest number in the nation. Sixty-one percent of residents get Medicaid or Medicare.
About 30 percent have commercial insurance, so there's a very low uninsured rate.
Of those on Medicare, 73 percent take part in Medicare Advantage plans.
Of its 3.6 million citizens, 1.2 million participate in Medicaid. All of them are in managed Medicaid plans.
The issue for MMM and other insurers is that Puerto Rico gets reimbursed at 40 percent less than what is paid in the United States, Gonzalez said.
The cost of living is high because taxes and the price of electricity is high.
Despite the fact that MMM has a 4.5 star rating for its Medicare Advantage plans, its doctors in the network get paid about a fifth less than their counterparts in the continental U.S.
"We have to constantly innovate," Gonzalez said. "We have problems not typical of a health insurer."