Hartford HealthCare is working with Tufts Health Plan to launch CarePartners of Connecticut, a new health insurance company that brings together healthcare providers (HHC) with a health plan expert (Tufts Health Plan). CarePartners of Connecticut will offer Medicare Advantage plans to eligible beneficiaries, pending approval by the Centers for Medicare and Medicaid Services.
Dr. Jim Cardon is a practicing cardiologist, CEO of Integrated Care Partners and executive vice president & chief clinical integration officer for Hartford HealthCare. Through these roles, he has played an integral part in bringing CarePartners of Connecticut to life.We had a chance to sit down with him to discuss this new joint venture.
Network News: Why does Hartford HealthCare want to get into the health insurance business?
Dr. Jim Cardon: A lot of what we’re trying to do is bring value to things that are typically not paid for in a fee-forservice model. So, it was not so much a desire to become an insurance company. It was a way of finding a productive partnership and configuring it in a way that allows us to continue our journey to deliver more value-based care.
NN: What is Medicare Advantage and why did you choose to start with that?
JC: Medicare Advantage plans are provided by private insurance companies. The government pays a premium for every individual who joins the plan. What makes Medicare Advantage so unique in terms of opportunity is the clarity in the way the program sets up. This allows us to overcome the challenges that arise as payers and providers come together.
NN: From a business point of view, how will CarePartners strengthen HHC financially?
JC: HHC is creating a new delivery model focused on a system of care. We need to solve the issue of how we are paid for care that supports the work we are doing. Currently in a fee for service model, nobody is paying when one of our nurses reaches out to a patient in a primary care office to help them manage heart failure, making sure that they are taking their medications, making sure they’re on a [care management] plan and following their diet. The only time that we’re getting paid is when patients come in for their primary care visit, which only covers the services provided in the office. By creating CarePartners of CT, our Medicare Advantage plan, we will have the funds for those additional resources. It’s a different way of getting paid for the type of care we’re providing.
NN: You’ve been a cardiologist for many years now.
JC: Longer than I care to admit.
NN: How would a plan like this have helped one of your patients?
JC: Medical care can be extremely complicated, especially if you have chronic conditions. I had this elderly woman with heart failure. We could not keep her out of the hospital. Finally, with the help of an APRN, we set up routine visits to my office. Through that, we were able to manage that patient for years without readmission. Same weak heart, same patient, same home setting, all of that is just having the time, attention and resources to manage all of these folks with chronic disease. So, if we execute well, this can be quite transformational from a patient perspective with the kind of support that we can provide to them by simplifying this entire process.
NN: How will CarePartners be different from other Medicare Advantage plans?
JC: This plan puts the primary care physicians in the center of the patient’s care, and is not asking a patient to find their way through the system. ICP and Tufts will really assist patients and make everything as streamlined and simple as possible.
NN: How does Tufts fit into this picture?
JC: This is a commitment of two organizations. Tufts Health Plan has long experience in not-for-profit care for seniors and working closely with providers in Massachusetts. Hartford HealthCare is committed to a different care model and a different delivery system. We are coming together to try and fundamentally disrupt the traditional model that’s been here in Connecticut.
NN: Why should this be important to Hartford HealthCare employees?
JC: Employees come to work every day saying one thing: “I want to be able to provide the best care that this system can provide to any patient who trusts us with their care.” And that is not just for the practitioners, it’s for everybody — the person delivering meals, providing respiratory therapy or ensuring that the rooms are clean and safe. They want to make sure that they have the ability to do the best job they can. We need to ensure that we have a financially stable institution. This plan is a step in the direction to create a revenue stream that supports the work that we’re all trying to do and allows employees the resources so they can focus on caring for our patients.