Health Care Organizations Succeeding with Medicare Advantage Plans

John Lovelace, president of government programs at UPMC Health Plan

Hospital and physician-owned Medicare Advantage (MA) plans have seen double-digit growth since 2015.

Axios, which tracks membership data from the Center for Medicare and Medicaid (CMS), reports that the largest organization in this category, Kaiser Permanente, grew 23 percent from 2015 to 2018, to almost 1.6 million members. The other 40 or so hospital- and physician-owned plans have also burgeoned, some by more than 40 percent.

Health systems acquiring, starting, or partnering with insurers is a growing trend, according to John Lovelace, president of government programs at the University of Pittsburgh Medical Center (UPMC) Health Plan in Pennsylvania. “The alignment of payer and provider is growing,” he says.

UPMC, which has one of the largest MA plans, has been offering Medicare coverage for almost 20 years, he added. With more than 190,000 members in western Pennsylvania and Ohio, Lovelace says that seniors like the plans because they offer more flexibility than traditional Medicare. “We have a variety of plans. We have $0 premium plans, along with $0 deductible plans, and $0 cost-share plans,” he says.

“As a whole, we’ve had a remarkable track record,” he adds. “We’ve been growing every year; we’re successful. We make modest profits and move this product out into new geographies. We’ve merged with several health systems in the past few years, creating new partnering opportunities, and bringing a different metric to the market.”

With an estimated 3 million members in hospital-owned MA plans, experts attribute industry growth to several tried-and-true reasons: access, affordability, and quality of care. It’s not only good business; it’s good medicine.

Read the full article now: Is a Hospital-Sponsored Medicare Advantage Plan Right for Your Organization?

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Matt Humphrey
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