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Another health plan targets people who are dual eligible for Medicare Advantage-as-a-service.

The regional insurance company is betting on a growing number of seniors with very complex needs to fuel its geographic expansion.

MVP Health Care, which has 700,000 members, has partnered with Belong Health to create a joint venture that creates the first Special Needs Plan available in upstate New York and Vermont starting in early 2022. The company said 135,000 people in its existing geographic coverage are currently eligible for Medicare Advantage for high-risk individuals.

“We hope to start here and then expand our service area and use it as a tool to enter new markets,” said CEO Chris Del Vecchio. “This is such an unmet need that we think it will allow us to access markets that we wouldn’t normally enter. This is definitely an opportunity for growth. “

Del Vecchio declined to comment on which markets the non-profit payer is targeting to expand.

Dual eligible members represent some of the riskiest patients for insurance companies.

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Patients with a special needs plan are significantly more likely to have at least three chronic conditions than people enrolled in Medicare Advantage only or a paid Medicare program, with 43% reporting three to five chronic conditions and 50% saying they were minimum diagnosis. six chronic conditions, according to a recent study by the Commonwealth Foundation. Twice-eligible respondents were also more than twice as likely to identify as black and three times more likely to identify as Hispanic than members of Medicare Advantage or traditional Medicare. Statistically, these populations have lower incomes and poorer health than whites. According to the Commonwealth Foundation, white people are half as likely to participate in special needs programs.

By better coordinating care and connecting patients to community resources focused on the social determinants of health, MVP aims to improve patient outcomes. Orienting a health plan to caring for the most severe patients also provides an excellent opportunity to profit from treatment cost savings. MVP estimates that 60% of all Medicare enrollees will have multiple chronic conditions by 2030, opening the door for D-SNP plans to grow, Del Vecchio said.

“For the first few years, you don’t make money from these members,” he said. “You really care about the participants to bring them to the results they want.”

To create this new plan, MVP invested an undisclosed amount to help launch Belong Health, a “specialty company” that entered the market in June to help regional payers launch Medicare Advantage and Special Needs. Belong Health will combine its data and analytics tools with MVP’s healthcare management services to coordinate care for members, and will use its technology to help identify available community resources to tackle health inequities.

The company was founded by J. Patrick Foley, former president of Cigna, a $ 1.5 billion Medicare Advantage and Special Needs company in the mid-Atlantic region. Belong Health received an undisclosed seed investment from Maverick Ventures in June. The company is the first startup built on the Healthcare Foundry platform, which provides the technology foundation for young companies created to address specific challenges in the healthcare industry.

Belong Health and Healthcare Foundry aren’t the only startups looking to capitalize on the $ 343 billion Medicare Advantage market.

Earlier this week, digital health startup nirvanaHealth launched Aria Medicare, a cloud-based platform designed to serve as a one-stop shop for health insurance plans looking to get into the fast-growing and lucrative privatized government program for the elderly. Aria Medicare bills itself as “Medicare Advantage-in-a-box” and operates in the Amazon cloud. Former Apple and PepsiCo CEO John Scully is chairman of the parent company.

These tools represent a departure from how previous insurers entered the Medicare Advantage scope. Their launch reflects the growing interest in quick solutions to enter the lucrative Medicare Advantage marketplace.

Oscar Health, Clover Health and Alignment Healthcare have built their platforms from the ground up. Bright Health Group has grown substantially through the acquisition, purchase and creation of regional Medicare Advantage plans.


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