Many large for-profit Medicare Advantage insurers are working more closely with providers than ever before, but perhaps only Universal American Corp. has taken the concept of a partnership this far. The MA sponsor is working with providers — especially long-term care facility operators — to start MA Special Needs Plans in rural areas, including ones in which the new SNPs might be competing against Universal American’s own MA plans. The insurer takes the actual risk, runs the insurance functions and helps put up the capital in return for taking 50% of the net profits in a five-year agreement.
Universal American has a track record in building new businesses from scratch, but this one is unusual by any standards. And this kind of partnership may be just as strange for providers, some of which still have scars from previous efforts, especially in the 1990s, to “cut out the middleman” and form their own Medicare plans.
Stephen Wood, senior vice president, development at Universal American, tells AIS the climate is different this time, given the availability of better data, the needs for population health management and alignment of incentives — and perhaps most significantly the expected boom in business for managing Medicare-Medicaid dual eligibles. He says the insurer may have a handful of such SNP partnerships operating in rural areas next year and perhaps a dozen operating within 36 months.
What do you think of this concept? Has the climate changed enough so that providers and MA insurers can jointly own an MA plan and live happily ever after? Are the desires of providers to be “masters of their own destiny,” as Wood puts it, and the duals opportunity strong enough that they’re willing to be equal partners with organizations they not long ago regarded as their enemies? Is this the wave of the future or an aberration that may get drowned quickly?
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