New Medicare Advantage plans to target diseases such as diabetes, high blood pressure

Oct. 05--Five insurance carriers in Pennsylvania are betting they can make patients healthier starting next year, despite the presence of certain chronic medical problems, while bringing down the overall cost of health care.

Just don't look for anything about the new Medicare Advantage plans in fliers or advertisements. Medicare prohibits participating insurance companies from talking up the plans unless people specifically ask about them.

Aetna, Highmark and UPMC Health Plan in Western Pennsylvania, Geisinger Health Plan in Danville and Independence Blue Cross in Philadelphia will introduce Medicare Advantage plans in 2017 for people with seven chronic medical conditions. The product line will offer individualized benefits to encourage members to better manage problems such as diabetes and high blood pressure.

"Our focus is making the care more affordable," said Bob O'Connor, executive director of Aetna's Medicare Advantage plans in Pennsylvania, West Virginia and Delaware. "We're able to introduce care creativity."

Medicare calls the value-based plans "clinically nuanced," which allows the carriers to eliminate some co-pays and enhance care management to improve members' health and -- with some luck -- reduce overall health care costs for the insurer. The risk is member care could wind up costing insurers more than anticipated.

Until now, insurers were required to offer the same benefits and cost sharing arrangements to all Medicare Advantage members, regardless of individual member health problems.

Seniors with chronic obstructive pulmonary disease, congestive heart failure, history of stroke, heart disease and mood disorders are also eligible for the coverage, which is designed to encourage members to get the best possible care. Those conditions are among the most costly to treat, but pricing for the new coverage has not been released.

In addition to Pennsylvania, the plans will be rolled out in six other states in January. The Center for Medicare and Medicaid Services will expand the offerings to Alabama, Michigan and Texas in 2018, while adding rheumatoid arthritis and dementia to the list of chronic conditions that insurers can wrap benefits around.

"It's pretty innovative," said John Lovelace, president of UPMC for You, the Pittsburgh insurer's Medicare Advantage program. "It's a radical departure from everything has to be the same for everybody, giving people some room to maneuver and allowing more creativity."

In a written statement, Highmark spokeswoman Wendy Morphew said the Pittsburgh insurer was excited about participating in the program's first year. "Highmark is always on the lookout for innovative approaches and eager to test new models to see if they improve the quality of care for our members," she wrote.

Medicare Advantage carriers receive a flat, per member per month reimbursement from the government, so insurers will be able to pocket any savings that accrue from the new plans.

Participating carriers are prohibited from publicizing specifics of their offerings, which could restrain sales of the products for insurers. But the levers available to improve member health include reducing cost-sharing for specific prescription drugs, doctors, hospitals and other medical agencies that provide superior care, according to Medicare.

Since the 1970s, seniors have been able to receive Medicare benefits through private insurers, with the number of people enrolling in such plans more than tripling to 17.6 million members in 2016 since 2004, according to the nonprofit Menlo Park, Calif.-based Henry J. Kaiser Foundation, a research group. Overall, 31 percent of seniors are enrolled in Medicare Advantage plans, with a penetration rate of about 50 percent in Allegheny County.

Kris B. Mamula: [email protected] or 412-263-1699

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