Some healthcare professionals in eastern Connecticut think they have an improved recipe for healthcare: Get rid of HMOs.
A group of more than 500 doctors has joined the Mashantucket Pequot Tribe and a Connecticut-based insurance broker to offer a new plan, dubbed "Senior Solution," for senior citizens dropped by their Medicare HMO carriers.
The plan was a response to the announcement last month that several HMOs plan to drop coverage for thousands of senior citizens in New London and Windham counties.
"The HMOs have clearly stated they no longer want to be in eastern Connecticut," said Anthony Alessi, M.D., who heads the physicians' group. "They no longer want to provide care for our sickest and most vulnerable citizens. We as communities in eastern Connecticut need to hold the door open and let them leave."
Aetna U.S. Healthcare, MD Health Plan, Oxford Health Plans and Physicians Health Services all announced last month their plans to drop Medicare coverage. Many insurers nationwide are cutting back on their Medicare business, citing low federal reimbursement rates.
Between 5,000 and 6,000 senior citizens in eastern Connecticut and tens of thousands more across the Northeast are to be dropped from the HMO rolls starting Jan. 1.
Senior Solution combines the services of the physicians, the Pequot Pharmaceutical Network and Wallingford, Conn.-based American Financial Services. Coverage will begin in January for seniors enrolled by Nov. 15. The tribal-owned pharmacy network has provided group insurers and employers with prescription programs since 1991.
The partnership was hailed as a potential national model because it eliminates HMOs.
"The beauty of today's plan is that it's not just an eastern Connecticut plan," said Alessi. "It's a plan that can be easily reproduced anywhere in the United States."
Nationally, more than 500,000 Medicare beneficiaries will have to change health plans because of HMO pullouts from Medicare risk contracting (Nov. 2, p. 23).
The new plan will cost more than customers typically pay to HMOs, said Bob Vitale, president of American Financial Services. The advantage, he said, is that coverage will not be withdrawn.
Because the insurance companies are regulated by the state, unlike HMOs, the new arrangement will prevent a scenario like the HMO withdrawal, Alessi said.
Vitale declined to say how much customers would have to pay for the new plan. He said the variety of coverage combinations among the 10 insurance carriers made it difficult to give an average cost.
Alessi said the number of seniors who can join the plan is unlimited.
"We only have 9,000 in eastern Connecticut, and we can take them all," Alessi said.
State Sen. Edith Prague (D-Columbia) said the HMOs brought the idea of HMO-less health coverage on themselves.
"I can't help but think the HMOs are finally getting theirs," Prague said. "You can only push people so far, and then they dig in their heels and you won't be able to push them any further."