SummaCare, UH to co-brand Medicare managed-care plans

Sept. 12--SummaCare is adding the University Hospitals name to its Medicare managed-care plans in communities where the Cleveland-based health system has hospitals.

It's a way for the Akron-based insurer to get its name in areas it may not be as well known and to grow its network, particularly in Portage, Cuyahoga and Geauga counties and parts of Lorain County, said Anne Armao, SummaCare vice president for marketing and consumer engagement.

"We want to grow in key areas where (UH) has hospitals," Armao said. "We want those eligible for Medicare that don't know if they prefer University Hospitals, they can choose SummaCare and get access."

The Medicare managed-care insurance plan will be known as University Hospitals Medicare Advantage from SummaCare.

SummaCare currently has more than 24,000 enrollees in its Medicare managed-care plans across Northeast Ohio, said Armao.

SummaCare is the largest Medicare managed-care insurer in Summit County with 12,251 members, according to August numbers from the U.S. Centers for Medicare and Medicaid Services.

It has room to grow in other counties: Cuyahoga County has 1,126 SummaCare Medicare managed care enrollees; Geauga, 99; Portage, 1,951; and Lorain, 470.

"This is a vital collaboration that will prove beneficial to both organizations, and most importantly, to our Medicare Advantage members," Armao said in a prepared statement. "We expect our members to achieve improved quality of care, better health outcomes and an overall outstanding patient experience."

The list of in-network UH doctors that SummaCare Medicare enrollees can see won't change, but there will be "care navigators" to help offer more holistic, coordinated care, said Brent Carson, vice president for managed care contracting at UH.

Financial details of the agreement were not disclosed.

Carson said UH will be taking on more financial risk in the arrangement, rather than simply being paid a flat fee for providing care. This payment shift is part of an industry trend.

"The logic is hospitals and providers need to have an incentive while controlling costs," he said.

The UH-SummaCare partnership is the only one that UH will be pursuing for a Medicare Advantage plan, Carson said.

Armao said SummaCare already has a similar holistic, coordinated care arrangement with its parent, Summa Health.

"We don't want people to think 'I have to sign up for UH to get better care.' We're just saying we're working more collaboratively together," she said.

SummaCare customers can also mix and match providers in different hospital networks, such as UH and Summa, she said.

When asked whether the deal could signal more partnerships or even the potential of UH becoming a potential suitor for the financially strained Summa, both Armao and Carson said the partnership is strictly about the Medicare product only.

But J.B. Silvers, health finance professor at Case Western Reserve University's Weatherhead School of Management, said if the partnership works well, he could see more coming.

The insurance partnership makes sense, said Silvers, a former SummaCare board member who served as president and chief executive of UH's now-defunct insurance company, QualChoice.

UH wants to "drive volumes to their hospitals and systems. This gives UH another route to do that," said Silvers. "They probably think they can get a marketing or price advantage by doing it this way relative to the contracts they have with other Medicare Advantage plans."

Medicare Advantage managed-care plans are optional for everyone covered by Medicare, the federal health insurance program for people 65 or older and some younger disabled Americans.

The federal government contracts with private insurance companies to provide coverage to Medicare recipients who sign up for the plans. Everyone but the poorest pay a portion of the monthly premium if one is charged to consumers; the government picks up the rest of the cost.

A marketing campaign touting the Summa-UH collaboration is being launched where UH has hospitals and physicians.

On Oct. 1, insurers can start offering details about Medicare plans available for 2018. Enrollment begins Oct. 15 for coverage effective Jan. 1.

Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or http://www.facebook.com/BettyLinFisherABJ and see all her stories at http://www.ohio.com/betty

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