Another health plan targets dual-eligibles through Medicare Advantage-as-a-service

A regional health insurer is banking on the growing number of seniors with highly-complex needs to fuel its geographic expansion.

MVP Health Care, which counts 700,000 individuals as members, has partnered with Belong Health to launch a joint venture that creates the first Special Needs Plan available in upstate New York and Vermont, which starts at the beginning of 2022. The company said 135,000 individuals in its existing geographic footprint are currently eligible for the Medicare Advantage plan for high-risk individuals.

“We hope to start here, and then grow it across our entire footprint, and use it as a vehicle for expansion into new markets,” CEO Chris Del Vecchio said. “It’s such an unmet need, we think it’ll allow us to access markets that we wouldn’t ordinarily enter. It definitely is a growth opportunity.”

Del Vecchio declined to comment on what markets the not-for-profit payer was targeting for expansion.

Dual-eligible enrollees represent some of the riskiest patients for insurers.

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Special needs plan patients are significantly more likely to suffer from at least three chronic conditions than individuals enrolled in just Medicare Advantage or fee-for-service Medicare, with 43% reporting three to five chronic conditions and 50% saying they were diagnosed with at least six chronic conditions, according to a recent study by the Commonwealth Fund. Dual-eligibles were also more than twice as likely to identify as Black and three times as likely to identify as Latino than enrollees in Medicare Advantage or traditional Medicare. These populations are statistically more likely to be low-income and have poorer health than white people. White individuals are also two-times less likely to enroll in special needs plans, the Commonwealth Fund found.

By better coordinating care and connecting patients to community resources that address social determinants of health, MVP aims to inspire better patient outcomes. The health plan’s focus on caring for the sickest patients also offers the greatest opportunity to profit off of saved care costs. By 2030, MVP estimates that 60% of all eligible Medicare enrollees will have multiple chronic conditions, offering a growth opportunity for D-SNP plans, Del Vecchio said.

“The first few years, you’re not making money on these members,” he said. “You’re really caring for the members to get them to the outcome that they need.”

To build this new plan, MVP invested an undisclosed sum to help launch Belong Health, “a built-for-purpose company” that entered the market in June to help regional payers start Medicare Advantage and Special Needs Plans. Belong Health will pair its data and analytics tools with MVP’s care management services to coordinate care for enrollees, and will also use its technology to help identify available community resources to bridge healthcare inequities.

The company was started by J. Patrick Foley, the former president of Cigna’s $1.5 billion Medicare Advantage and Special Needs business in the mid-Atlantic region. Belong Health received an undisclosed seed investment from Maverick Ventures in June. The company represents the first startup built on the Healthcare Foundry platform, which provides a technology backbone for young companies built to solve specific healthcare industry problems.

Belong Health and Healthcare Foundry aren’t the only startups looking to cash in on the $343 billion Medicare Advantage market.

Earlier this week, digital health startup nirvanaHealth launched Aria Medicare, a cloud-based platform that aims to serve as a one-stop shop for health plans looking to get into the fast-growing and lucrative privatized government program for seniors. Aria Medicare markets itself as “Medicare Advantage-in-a-box” and runs on Amazon’s cloud. Former Apple and PepsiCo CEO John Sculley serves as chairman of the parent company.

These tools represent a departure from how previous insurtechs have entered the Medicare Advantage space. Their launch signals growing interest for quick solutions to join the lucrative Medicare Advantage market.

Oscar Health, Clover Health and Alignment Healthcare all built their platforms in-house from the ground up. Bright Health Group has essentially grown through acquisition, by buying and building up regional Medicare Advantage plans.