🔒Q&A: UMass Memorial’s insurance plans

In September, Mary Hsieh became the first CEO of the newly created Mass Advantage, the insurance offered by Worcester healthcare provider UMass Memorial Health and its partners, Shields Managed Care Solutions, LLC in Stoughton, and WCAS CM Holdings LLC of Delaware. The insurance is offered to all Worcester County residents eligible for Medicare and is known as a Medicare Advantage plan, which offers more benefits than the government health insurance. Coverage for the first members starts Jan. 1. 

How’s your team feeling with Jan. 1 approaching?

It is incredibly energizing to build something from the ground up. You really are not inheriting the baggage of an existing infrastructure with an historical past. Everyone on the team feels like we could do something really different from other Medicare Advantage plans.

Coming off the coronavirus pandemic, too, people are going to back what matters. This crisis really taught us what’s important, and we can anchor Mass Advantage to what really matters.

So, what really matters?

From a member perspective, it is: When can I see my doctor? Can I access care when I need it? Will my insurance make things easier? Will I be able to access the latest medical advancements?

That should be a simple answer, but it isn’t currently. Right now, the insurance process doesn’t make the patients' lives easier. It doesn’t make the providers' lives easier either.

From the provider perspective: Doctors are busy fighting the pandemic, and they want to see changes. We’ve gone on a listening tour to find out pain points for doctors and other providers.

How do you make all their lives easier?

This is where UMass Memorial Health becomes so important in what we do. Working so closely with a provider like that allows us to be very specific to the benefits we offer to our patients.

For example, the Hospital at Home program was developed by UMass Memorial Health for certain individuals to receive hospital-level care in the comfort of their own home. This is designed specifically for the community, and we can bring that to bear for our members, because we want them to use that service.

The amount of enthusiasm and interest for something like this wrapped around a health system UMass Memorial Health has been outstanding. I know we are going to do great things together.

Can patients only be treated at UMass Memorial Health?

No. Although we are anchored by UMass Memorial Health, Mass Advantage has a very broad network. There are HMO and PPO options, and our members can use a number of healthcare providers.

Is this type of insurance modeled after something?

Medicare Advantage plans have been seeing huge growth across the nation. All Medicare-eligible people can choose a Medicare Advantage plan, which will offer benefits at least equal to Medicare benefits, with the option to offer significantly more. We can offer comprehensive dental plans, comprehensive vision coverage. Our members can buy over-the-counter health products on the plan.

Unlike traditional Medicare where patients will always be responsible for a portion of their care, Medicare Advantage plans have caps on how much patients have to spend out of their pocket.

How is the market growing for Advantage plans?

There has been a big bump because of Baby Boomers aging into a Medicare-eligible window, and more members want to use a Medicare Advantage plan. Right now, 39% of Medicare-eligible people in Worcester County use a Medicare Advantage plan, so there is plenty of more market share out there.

Will Mass Advantage grow quickly once it starts?

Yes, because we are building a great program. Our leadership team comes with significant experience. I have helped a number of health plans develop their Medicare plans, throughout the country, so I know what patients and providers are looking for.

This is not our first tour doing this, for our entire leadership team.

This interview was conducted and edited for length and clarity by WBJ Editor Brad Kane.