Payer, Provider Launch Wellness-Focused Medicare Advantage Plan

MVP Health Care and the University of Vermont (UVM) Health Network plan to form a Medicare Advantage plan with an emphasis on wellness, the non-profit payer and academic healthcare system announced.

"With a shared mission of creating innovative solutions and sustaining healthy communities, MVP Health Care and the UVM Health Network will enthusiastically co-create a health plan that supports stronger relationships between members and physicians, and will positively impact the communities we serve,” said Christopher Del Vecchio, president and chief executive officer of MVP Health Care.

The health plan will be available to residents in Vermont and the northern region of New York. Beneficiaries will be able to enroll in MVP Health Care and UVM Health Network’s plan during open enrollment of 2022, with the benefits going into effect on January 1, 2022.

While the granular details will not be available until open enrollment, the health systems indicated a couple of key aims for the new plan.

The MVP Health Care-UVM Health Network health plan will focus equally on wellness and sickness.

Emphasizing preventive care services can be a key marker of a wellness-centered health plan.

Payers can affect that change from being driven by illness to being driven by wellness through individual- and community-level interventions. Those interventions can range from screening events that are available to the entire community to personalized technologies that offer targeted solutions.

The plan will also seek to control healthcare spending. The press release indicated that the health insurer and academic health system will leverage value-based care frameworks such as the All Payer Model in Vermont or the payment reform initiatives in New York.

Preventive care is a value-based care strategy that payers often utilized to reduce healthcare spending.

By taking steps to lower members’ risk of developing chronic conditions and by catching diseases early, health plans diminish the likelihood of members having to undergo high-cost procedures. Even for the most expensive conditions in the US—including heart disease, stroke, cancer, and diabetes—payers can lower costs through screenings and wellness programming.

During the coronavirus pandemic, payers turned to in-home screening kits to continue supporting their members’ preventive care needs.

Another potential wellness-centered strategy is wellness programming.

Experts’ opinions are mixed as to whether or not wellness programming is effective at reducing healthcare spending. Most recently, researchers found that a wellness program that focused on helping members lose weight could save the nation $8 billion over the course of three years, if one out of every six obese patients joined the program.

But other data demonstrates that wellness programs face challenges that prevent members from experiencing positive results. Long-term commitment to the wellness program and company culture can be influential factors that may determine whether members achieve their goals and, ultimately, reduce the plan’s healthcare spending.

In addition to focusing on pursuing wellness and reducing healthcare costs, the new Medicare Advantage plan will be provider-driven. The partners put a strong emphasis on the fact that local providers would be integral to their approach.

“We realize our patients have choices when it comes to Medicare Advantage plans. Our intent is to give them a better option that is tailored to their health care needs by offering a unique plan shaped by our experienced, local providers,” said John R. Brumsted, MD, president and chief executive officer of UVM Health Network. 

“By reinforcing vital provider relationships, focusing on improving the lives of people in our communities, and leaning on the patient-centered missions of our two organizations, we will make health insurance more convenient, more supportive and more personal,” agreed Del Vecchio.