In a crowded market dominated by the Blues, a hospital-owned health plan is trying grow in tandem with Medicare and Medicaid enrollment, seeing potential in suburban Baby Boomers.
Health Partners Plans, a managed care nonprofit serving Medicare, Medicaid and CHIP beneficiaries in greater Philadelphia, is adding a new provider to its Medicare network, aimed at drawing urban and suburban seniors interested in an Ivy League academic health system.
The University of Pennsylvania Health System is joining the network of Health Partners' Medicare Advantage plan network -- greater Philadelphia's newest and fastest growing MA plan -- after several years in its Medicaid network.
Founded in 1984 to serve Medicaid managed care beneficiaries, Health Partners is owned by Aria Health, Einstein Medical Center, Tenet's Hahnemann University Hospital, the independent St. Christopher's Hospital for Children and Temple University Health System.
The nonprofit managed care organization started Medicare managed care plan in the 1990s and grew enrollment to 22,000. But amid reimbursement challenges in 2007 sold it to Elder Health, which is now the HealthSpring Medicare Advantage company owned by Cigna.
In 2014, though, Health Partners reentered the Medicare market and surpassed its own projections, enrolling some 10,000 seniors in its five county service area around Philadelphia.
The region is home to tens of thousands of Baby Boomers across large swaths of fairly affluent suburbs and middle class communities, and today the local Medicare Advantage market is more competitive than when Health Partners exited, with offerings from Gateway Health, Aetna's Coventry and Independence Blue Cross and its AmeriHealth Caritas subsidiary.
But Health Partners believes the time is right to re-enter the market, and that its unique ownership structure will resonate with potential members, who may have had a taste of a high deductible plan or narrow network HMO before retirement.
With 30 hospitals and some 5,000 physicians already in its network, Health Partners is offering more choice and prestige with the addition of the University of Pennsylvania's Penn Medicine, a network of four hospitals and 1,300 physicians.
"The University of Pennsylvania Health System has a long history of medical leadership in the region," said William George, Health Partners Plans' president and CEO since 2006. "We are constantly looking to add highly skilled and qualified medical professionals to our network to better serve all of our members,"
Health Partners is selling four different Medicare plans: a "Prime," "PrimePlus" and basic HMO, as well as a Dual-Eligible Special Needs Plan, all with no monthly premiums, no-cost diagnostics and labs, and fitness and Weight Watchers memberships.
In Medicaid managed care and CHIP, Health Partners has seen a fair amount of success. In 2014, for instance, it was ranked as the number one Pennsylvania MCO by the National Committee for Quality Assurance, and in 2013, it was one of just three of the state's eight MCOs to earn an operating profit.