Connecticut has never seen anything like CarePartners of Connecticut, a joint venture between Hartford HealthCare and Tufts Health Plan of Massachusetts, that will begin selling 2019 Medicare Advantage plans in the state when the open-enrollment period begins Oct. 15.
It’s the first partnership between a hospital system and an insurer that provides senior citizens with Medicare benefits and additional dental, vision and hearing coverage.
In uniting a healthcare system with an insurer, CarePartners of Connecticut will offer competitively priced coverage with primary care physicians providing both care and navigation through the Medicare system. Tufts, with 98,000 enrolled customers, has the highest quality rating (five stars) from the Centers for Medicare and Medicaid Services.
“Medical care can be extremely complicated, especially if you have chronic conditions,” says Dr. James Cardon, a cardiologist, CEO of Integrated Care Partners and Hartford HealthCare’s executive vice president and chief clinical integration officer. “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, [CarePartners] can be quite transformational from a patient perspective with the kind of support that we can provide to them by simplifying this entire process.”
CarePartners of Connecticut will offer three CareAdvantage plans, with fixed-dollar copays a notable feature.
“That was a big pain point that we heard through our customer research,” says Marc Hudak, CarePartners of Connecticut president. “So if you’ve got a coinsurance where you owe 20 percent of an outpatient surgery? Well, 20 percent of what amount? . . . So, as best we could, we moved from co-insurance to fixed-dollar copays.”
Research also revealed that Medicare patients, on average, use three prescriptions a month. The pharmacy, essentially, becomes the most-used service in the healthcare system.
“We want to make sure that the drugs they actually need are not only on our formulary but on a low tier,” says Hudak, “because that’s where the copays are the lowest. And we don’t have the pharmacy deductible. So we keep it simple for patient and providers: 90-plus percent of the drugs that seniors use most are on tier one of our formulary. So our doctors don’t have to worry about whether the patient can pay for a prescribed drug.”
Medicare Open Enrollment for 2019 coverage is Oct. 15 through Dec. 7. For more information about CarePartners of Connecticut, including complete plan comparisons and how to enroll, click here.