More than 371 counties nationwide will witness a mass exodus from Medicare risk HMOs, according to The Managed Care Information Center (MCIC), an Internet-based healthcare publisher and market research company in Manasquan, N.J.
These terminations - due to uneven and ultra-conservative Medicare reimbursement rates - are wreaking havoc politically and socially. The result is a call for industry communicators to adopt new strategies for Medicare marketing, member retention and product development.
The Healthcare Financing Administration (HCFA) projects the changes in available coverage will affect more than 400,000 Medicare risk beneficiaries - or seven percent of the total Medicare risk population nationwide. Many rural markets will be completely abandoned by Medicare risk plans.
MCIC is posting listings of the Medicare managed care plans exiting the risk market as they are announced on its Web site at http://www.themcic.com. Some of the well-publicized Medicare risk contract terminations and reductions include:
- United Healthcare terminating Medicare risk services in 86 of the 206 counties it serves;
- Foundation Health Systems failing to renew contracts in 32 counties in six states; and
- Aetna U.S. Healthcare withdrawing its Medicare risk HMO plans from six states and Washington, D.C.
There are, however, profitable solutions to making Medicare risk plans work, says Dr. Charles A. Peck of Arthur Andersen's healthcare consulting group, who previously ran a successful Medicare risk program.
To make Medicare risk plans profitable, he emphasizes managing medical costs better and "investing in programs that maximize preventive [care] and intervention services" in his "Ten Steps to Medicare Risk Viability."
The tips that address key marketing involvement include:
- Risk Assessment Methodology: twenty percent of the Medicare population generates 80% of the costs, so health plans need to identify the most vulnerable seniors in an HMO prior to joining the plan.
- Disease Management Programs: assess the health plan's high volume and cost diagnoses and determine what disease management programs are needed; important areas are congestive heart failure, diabetes and oncology.
- Physician/Manager-Friendly Reporting Tools: provide the health plan's physician leadership and executive management with "real time" market information that is accessible, understandable and relevant.
- Vision and Mission: once new programs are established, help your leadership develop vision and mission statements that are clearly and consistently articulated to employees and other stakeholder audiences.
(MCIC, 888/THE-MCIC; Arthur Andersen, Mary Moak, 404/221-4336)