Fallon, Reliant Ready For Split On Senior Coverage
Fallon Community Health Plan and Reliant Medical Group — once part of the same organization — will part ways in 2014 on a key insurance plan that covers about 18,000 senior patients, which could equal a loss in customers for Fallon.
Reliant, which has more than 20 physician locations throughout Central Massachusetts and MetroWest, will stop accepting the Medicare Advantage plan offered by Fallon on Jan. 1, and will only accept one offered by Tufts Health Plan. Reliant now accepts both plans, which combine regular Medicare coverage and supplemental insurance.
Whether Reliant patients will decide to stay with their doctors and switch insurance plans, or look for new providers that accept Fallon, is a matter of debate. Officials from each organization say patients could be enticed either way.
A sizeable group of Reliant patients is at stake. According to Fallon, about 30,000 are enrolled in its Medicare Advantage plan, and about 18,000 of them are Reliant patients. Other health systems that accept Fallon plans are UMass Memorial Health Care, Harrington HealthCare, Saint Vincent Hospital, Heywood Hospital and the Central Mass. Independent Physicians Association.
Fallon's presence as a major Medicare Advantage provider in the region is clear, according to data provided by the Centers for Medicare and Medicaid (CMS), which shows that 45,087 people were enrolled in Medicare Advantage plans in Worcester County in April.
According to Dr. Robin Richman, executive vice president of medical affairs at Reliant, Fallon and Reliant will continue to have a “significant relationship” as Reliant will continue to accept several other plan types offered by Fallon. But the decision to accept only Tufts' Medicare Advantage plan was driven by administrative concerns.
Richman said the Tufts plan leaves much of the case management involved in patient care up to the doctor.
Ending Administrative Burdens?
“We're making this change because we believe this will give us the ability to really make the most of the health care decisions between the doctor and the patient, rather than have the unnamed third party in the room,” Richman said.
Part of the advantage is that Reliant doctors will save time and money by reducing administrative duties now part of the arrangement with Fallon. “We can take that money and spend it on patient care issues and patient support more freely,” Richman said.
Reliant did not have information about how much money it will save due to the switch.
Asked how Reliant expects the switch to play out for its 250 physicians, Richman said it's likely that most patients will stay with their doctors, even if it means they have to switch plans, because of longstanding relationships.
In offering only the Tufts Medicare Advantage plan, Reliant seems to be following the lead of Atrius Health alliance, which includes seven health care organizations in Central and Eastern Massachusetts, including Reliant. All Atrius members offer only the Tufts plan, according to Reliant, though Reliant decided to phase out the Fallon plan before it became an Atrius member in 2011.
Fallon has prepared for the switch, according to Christine Cassidy, vice president of corporate communications, by expanding the company's geographic service area for its Medicare products. It was the largest service area expansion in Fallon's history, Cassidy said.
For existing patients covered by Fallon's Medicare Advantage plan, there are other products that Reliant will continue to accept that patients can swap their current plans for. Cassidy said Fallon has focused on community outreach through meetings and in its retail visitor center in White City Plaza in Shrewsbury, to inform patients of their options.
“There are obviously a lot of people here in Central Massachusetts who are impacted by Reliant's decision,” Cassidy said.
According to Reliant, 19 percent of its members are age 65 and older, while 81 percent are under 65.
Tufts: Most Fallon Patients Will Join In 2014
For its part, Tufts believes most Reliant Medicare Advantage patients will jump ship and be covered by the Tufts plan in 2014, according to Patty Blake, senior vice president of senior products at Tufts.
Blake said Tufts recently carried out a similar transition with Atrius member Harvard Vanguard Medical Associates of Newton. In that case, about 90 percent of Medicare Advantage patients formerly covered by other plans signed on with Tufts.
“What we're finding is these seniors are very connected to Reliant,” Blake said. “The vast majority are interested in maintaining those relationships.”
There are legal restrictions Tufts must abide by as it markets its plan in Central Massachusetts, however. Due to privacy laws, Blake said Tufts cannot directly reach out to Fallon subscribers unless they contact Tufts for information first. But the company is generating visibility through billboard and radio advertising, and by meeting with senior citizens at social-service agencies and senior housing complexes.
“We're very confident that we'll have a plan that will meet the needs of every Reliant patient,” Blake said.
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