These managed care plans are under pressure to reduce costs. Medicare Advantage plans expect to see $145 billion in cuts over 10 years and Medicaid managed care plans, which are growing as states try to reduce Medicaid expenses, could possibly see lower reimbursements as states push for more cuts.
“We don’t have the revenue lever that commercial plans have” to raise premiums, said Jason Feuerman, a senior executive for HealthSpring, operator of Bravo Health, a plan for Medicare and Medicare patients that runs a clinic in Philadelphia. Bravo Health estimates hospital stays have fallen 10 percent among the 20,000 patients living near the clinic.
Humana, a big player in Medicare Advantage plans, runs six urgent-care clinics in the Philadelphia region since its Dec. 2010 purchase of Concentra, a Texas-based urgent-care chain. “We wanted to give people alternatives to the emergency rooms,” said Paul Kusserow, Humana’s chief strategy officer.
The number of managed care-run clinics across the country declined in the late 1990s, as customers rejected plans that provide limited choices of providers. With millions expected to join Medicare and Medicaid under healthcare reform, “it makes a lot of sense to prepare for that demand,” said Peter Kongstvedt, a managed care consultant.
Read the Philadelphia Inquirer report on Medicare Advantage plans.
Related articles on Medicare Advantage plans:
Excess Costs of Medicare Advantage Plans Declining
Humana Shares Surge as Result of New Medicare Advantage Reimbursement Rates
$6.7B Bonus Saves Many Medicare Advantage Plans From Losses
