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Health Plan, WVU unveil new program

CHARLESTON — A planned merger by two West Virginia health care companies is leading to a new Medicare Advantage plan for seniors that could provide savings for seniors.

The Health Plan, based in Wheeling, and WVU Medicine announced Friday they are teaming up to offer the Medicare Advantage plan called Secure Care – WVU Medicine + The Health Plan.

The new Medicare Advantage plan will allow seniors access the WVU Medicine network of hospitals, clinics, and health care providers, but at lower monthly premiums and lower out-of-pocket expenses. It’s the first big step in the partnership between The Health Plan and WVU Medicine since the two companies announced their merger to create an integrated health care network deal in May 7.

“We’re very excited about this new Medicare advantage plan,” said Albert Wright, CEO of WVU Medicine. “The whole reason we’re coming together with The Health Plan…is that we believe the only way you can ever truly lower the cost of health care and improve the coordination and outcomes is when the payer, i.e. the insurer, and the provider are financially aligned and moving in the same direction.”

Patricia Fast, senior vice president of government affairs for The Health Plan, said the partnership would provide a great clinical and insurance link for seniors who use The Health Plan across the state.

“We’ll be able to utilize a lot of WVU Medicine’s clinical staff to help support a lot of our outreach programs to our members,” Fast said. “We’ll be able to share a lot of data so that they can better manage the patient population to the fullest, and just make sure that…our Medicare members have an opportunity to get better health care through both of our combined systems working proactively together with the population.”

According to the University Health Consortium data cited by Wright, you can cut the cost of health care in half when a patient receives care in an integrated system versus care through multiple systems.

“You’ve got smooth transitions from physician office to hospital because all of that information – all of your labs, prescriptions, x-rays, position, progress notes – are shared between your providers,” Wright said. “It’s safer because everybody has your information and it’s very easy for our care coordinators to follow your care and intervene and get you to the right levels.”

A Medicare Advantage plan – or a Medicare Part C plan – is different than a typical Medicare program. Instead of being ran by the government, it allows seniors to choose a private insurance company that contracts with Medicare. A Medicare Advantage plan can often provide additional benefits a normal Medicare plan does not, such as vision or dental coverage.

In addition to access to WVU Medicine health care facilities and doctors, participants of the Secure Care plan will have access to WVU’s Nurse Navigator telephone line. The program gives participants access to registered nurses around the clock and seven days a week at no cost.

“Here we have in excess of 100 clinical people, nurses, social workers, and pharmacists that can get engaged with that member and help navigate them through the process,” said Jim Pennington, CEO of The Health Plan.

“Quality is extremely important,” Pennington continued. “Engagement with the Medicare population, the senior population, is big. They like to be engaged and they like to talk about and manage their health care. If they can speak to a nurse that or a pharmacist that helps move them through the process, they’ll take the time to do so. We just have to make the system streamlined enough that it’s effective for them.”

Other benefits include no co-pays for 90-day supplies of generic prescription drugs by mail order, as well as vision and dental services and options to purchase additional dental coverage.

Despite the Charleston Area Medical Center deciding to end its contract with The Health Plan over a disagreement with WVU Medicine, Pennington said there are more than 100 doctors in the Kanawha Valley that participate in WVU Medicine’s system. But Wright acknowledged that both WVU Medicine and The Health Plan will need to partner with health care providers in the southern part of the state.

“If you look at where most of our care is, it’s in the Northern part of the state,” Wright said.

“We’re going to need to work with systems in Huntington and systems in Charleston to really make this work and improve the health of the population, and then improve the health trajectory of the state.”

“Our challenge in West Virginia is geography as much as population,” Pennington said. “It’s difficult because of the spread of this state to be able to do an integrated health care system without cooperation.”

“We believe this product – working with others but focusing on WVU Medicine hospitals – will allow us to ultimately provide lower costs and better coordinated care with the best possible outcomes,” Wright said.

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