Cleveland Clinic, Humana launch co-branded Medicare Advantage plans
Cleveland Clinic is starting two co-branded Medicare Advantage (MA) plans with Humana, which has the second largest MA member population behind UnitedHealthcare.
The two companies will launch the offerings, which includes an HMO and a plan for dual-eligible special needs members, on Oct. 15, which is the start of Medicare open enrollment.
- This is Cleveland Clinic’s second co-branded partnership with an insurer. Earlier this year, it partnered with Oscar on an individual market plan.
The Humana Cleveland Clinic Preferred Medicare Plans will be available in Cuyahoga County and members will have access to the Cleveland Clinic Health System, which includes the main campus hospital, 10 regional hospitals and more than 150 outpatient locations.
The partnership is based on a value-based care design that includes no monthly premiums, no copays for primary care physician office visits and no costs for a 30-day supply of Tier-1 prescription drugs. Also, unlike other HMOs, patients won’t need referrals to see in-network specialists. One tenet of value-based benefit design is offering low or no-cost care in hopes that members will get less expensive preventive care rather than wait to see a doctor when health problems are further down the road.
The Cleveland Clinic/Humana partnership is the latest in a string of hospitals and health systems working with payers on insurance products. Nearby, University Hospitals announced last month that it’s working with SummaCare Medicare on MA plans.
Payers have also increasingly moved into the MA market and have benefited financially as a result. Humana announced this year that it’s completely leaving the Affordable Care Act (ACA) exchanges in 2018 and instead investing more in the MA population. Payers see more upside in the MA market, which gets a steady stream of healthier Baby Boomers entering each year to help offset the sicker, older members. UnitedHealth even said earlier this year that it expects half of all Medicare beneficiaries will have an MA plan one day.
Payer-provider partnerships are also on the rise. About 200 have launched in the past five years, Thomas Robinson, partner at Oliver Wyman, recently told Healthcare Dive. The overwhelming majority emphasize value-based compensation in some way. "The point of these partnerships is to create something new, rather than just building the same old offerings with a narrow network. Successful partnerships will take the opportunity to innovate around the product and experience now that the incentives, insight, investment and integration are all for it," he said.
In more good news for the MA market, those with MA plans will have more choices and lower premiums in 2018, according to the CMS. Enrollment is expected to increase by 9% to 20.4 million in 2018, which is more than one-third of Medicare enrollees.
In addition to its MA plans, Cleveland Clinic’s is co-branding plans both on and off the Ohio ACA exchanges with Oscar next year. Consumers in Cuyahoga, Summit, Lorain, Medina and Lake counties will have the opportunity to sign up for a co-branded individual plan. The plan will match members with a Cleveland Clinic care team and an Oscar concierge team. Members will have free round-the-clock access to Doctor on Call and the health system’s Express Care Online.
- Cleveland.com Cleveland Clinic to enter the Medicare insurance market
- Healthcare Dive Payers see growth opportunities in Medicare Advantage
- Healthcare Dive Oscar, Cleveland Clinic team up to offer health plans in Ohio