Not-for-profit health system and Medicare Advantage insurance
provider seek to expand access to care and coverage, pending regulatory
approval
ORANGE, Calif. & SACRAMENTO, Calif.–(BUSINESS WIRE)–lt;a href=”https://twitter.com/hashtag/MedicareAdvantage?src=hash” target=”_blank”gt;#MedicareAdvantagelt;/agt;–Today, Sutter Health, a not-for-profit integrated health care system,
and Alignment Healthcare, a Medicare Advantage insurance provider,
announced the signing of an agreement that allows the two organizations
to work together to offer more health care and insurance coverage
options for Medicare-eligible residents in Northern California in 2020,
pending regulatory approval.
Alignment has filed an application with the Centers for Medicare &
Medicaid Services (CMS) to expand its Northern California service area.
If the application is approved, Alignment and Sutter would begin
offering new Medicare Advantage plans in the approved counties in
October 2019 and members could seek “in-network” care with
Sutter-affiliated and aligned physicians and facilities on Jan. 1, 2020.
“Sutter has a long history of launching new and innovative health care
solutions for the benefit of patients and our communities,” said Phil
Jackson, Sutter’s CEO of Health Plan Products. “This collaboration is
designed to introduce new Medicare Advantage plans for eligible
individuals and to help them shop for plans, find affordable coverage,
and gain access to high-quality health care.”
Medicare Advantage plans are offered by private health insurance
companies approved by CMS and must cover everything included in
traditional Medicare – hospital costs, doctors’ visits and outpatient
care. These plans often include extra benefits like prescription drug
coverage, vision, dental and hearing exams. Every year, Medicare
enrollees can review their health plan options in October and make
changes to coverage beginning the following January.
Managed care delivery models such as Medicare Advantage make it easier
for health care providers to coordinate care and practice preventive
medicine, avoiding emergency room visits and more costly treatment
plans. According to a study
by the Boston Consulting Group1, Medicare Advantage
patients pay less in out-of-pocket costs than patients in traditional
Medicare and, on average:
- Are twice as likely to receive preventive care
- Are half as likely to go to the emergency room
- Go home from the hospital one day earlier
- Are less likely to be readmitted to the hospital after discharge, and
-
Use fewer health care services, allowing providers to care for others
in need
The Congressional
Budget Office estimates that approximately 40 percent of all
Medicare beneficiaries will be enrolled in Medicare Advantage plans by
2020.2 Of the approximately 2 million Medicare-eligible
residents in Northern California, an estimated 850,000 are currently
enrolled in Medicare Advantage plans, according to CMS.
“The collaboration between Sutter Health and Alignment Healthcare is
centered on our customers,” said Dawn Maroney, Alignment’s consumer
president. “We are coming together to offer Medicare-eligible
individuals in Northern California more choice, designing health plan
products that will provide access and flexibility for specific
population age groups in most of Sutter’s existing service areas in
Northern California.”
Founded in 2013, Alignment Healthcare has created a model of health care
delivery that combines high-touch care coordination with AVA®,
its proprietary command center technology, to improve quality of care
and eliminate waste in the care system. The central nervous system of
Alignment Healthcare, AVA provides real-time reporting and predictive
analytics that allow care specialists to anticipate care, often before
it’s even needed. Now serving more than 60,000 members across three
states, the Orange, Calif.-based company is supported by
industry-leading investors and endorsed by influential parties including
former CMS administrators and best-in-class hospital systems and health
plans.
“Alignment is thrilled about this relationship with Sutter Health,” said
John Kao, Alignment Healthcare founder and CEO. “By working together, we
have the opportunity to offer more communities more access to care and
implement population health strategies that improve care and lead to
better health.”
About Sutter Health
Sutter
Health is more than 60,000 people strong thanks to its integrated
network of physicians, employees and volunteers. Rooted in Sutter
Health’s not-for-profit mission, these team members partner to deliver
exceptional care that feels personal. From physician offices to
hospitals to outpatient care centers and home services, they proudly
support the more than 3 million people in their care—nearly 1 percent of
the U.S. population, in one of the most diverse and innovative regions
in the world. Sutter team members adopt new technologies, make novel
discoveries and embrace creative thinking to help patients and
communities achieve their best health. From its street nurse program
that provides check-ups for homeless people, to telemedicine-aided
specialist consultations, to walk-in care clinics, to smart glass
technology, the Sutter Health team goes beyond traditional models to
make care more convenient and to nurture and empower people throughout
their medical journey. For more information about the Sutter Health
network visit: sutterhealth.org
| facebook.com/sutterhealth
| youtube.com/sutterhealth
| twitter.com/sutterhealth.
About Alignment Healthcare
Alignment Healthcare is redefining the business of health care by
shifting the focus from payments to people. We’ve created a new model
for health care delivery that cuts costs and improves lives by
unraveling the inefficiencies of the current system to drive patients,
providers and payers toward a common goal of wellness. Harnessing best
practices from Medicare Advantage, our innovative data-management
technology allows us to commit to caring for seniors and those who need
it most: the chronically ill and frail. With offices and care centers
across the country, Alignment Healthcare provides partners and patients
with customized care and service where they need it and when they need
it, including clinical coordination, risk management and technology
facilitation. Alignment Healthcare offers health plan options to
California residents through Alignment Health Plan, and partners with
select health plans in North Carolina and Florida to help deliver better
benefits at lower costs. For more information, please visit www.alignmenthealthcare.com.
1 https://www.bcg.com/publications/2013/health-care-payers-providers-alternative-payer-models.aspx
2
https://www.cbo.gov/sites/default/files/cbofiles/attachments/44205-2015-03-Medicare.pdf
Contacts
Alignment Healthcare
Alison Trinidad, 657-218-7730, [email protected]
Sutter Health
Sy Neilson, 916-643-1227, [email protected]
