Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoons for the latest edition.
Some health insurance plans advertise a network with top doctors or wellness discounts at local gyms. A new offering in the works from UnitedHealth makes a relatively unique pitch: "No member will ever live more than a 10 minute golf cart ride from a primary care doctor."
It's a specially tailored pitch intended for a unique audience, as UnitedHealth announced Wednesday a partnership with the Villages, the country's largest retirement community, located in central Florida, to create a private Medicare plan that will exclusively serve its 93,000 residents.
The new partnership reflects some larger trends in the health-care industry: It will attempt to tamp down on health-care costs by making a large investment in primary care. Unlike traditional insurance models, where full hospital beds generate the most revenue, the whole idea is to keep patients out of the hospital altogether.
"If we do our job right, for every one hundred patients we see, maybe two or three a year will go into a hospital," Villages Health chair Elliot Sussman says.
If the plan does indeed reduce high-intensity, hospital care — while keeping Villages residents healthy — it could be a model for other health plans to follow, Medicare-specific and otherwise.
Both the Villages and UnitedHealth see opportunity in the new partnership. For the retirement community, it's another amenity to offer residents. The Villages already includes movie theaters, six live entertainment locations, and the country's largest golf community (540 holes available on site). An easy-to-access health-care system would fit in well alongside those features.
"No matter how much golf is available, how much pickleball or rollerblading, if you don't have your health, it's pretty much irrelevant," Sussman says.
For UnitedHealth, it's a chance to make deep inroads into a community where 3,700 seniors age into Medicare each year — and two-thirds of the population is already eligible. With a high level of patient engagement, it will be easier to manage population health, argues UnitedHealth Group Chief of Medical Affairs Reed Tuckson.
"People, and seniors in particular, are more knowledgeable and more willing to be involved in their care," Tuckson says. "Those are two powerful engines that we can harness."
The Villages will build eight primary-care centers throughout its community, ensuring that it can meet the 10-minute golf cart ride litmus test. Each will be staffed by eight doctors who will handle a panel of 1,250 patients. The doctors will all be paid by salary as employees of Villages Health, taking away some of the incentives for faster care that exist in a fee-for-service system.
Patients will still have access to hospitals, including the nearby hospital system run by the University of South Florida, although the whole idea is to make primary-care doctors the primary source of health care.
"This is putting primary care front and center," Sussman says. "It's making sure that the first call people make, except if they're having something like terrible chest pains, that they would take the medical concern to their physician. If you have a terrible headache, instead of going to the ER, it's saying 'come here, and we'll have you seen right away'."
UnitedHealth, for its part, will open three stores in the Villages where seniors can learn more about the health plan, mirroring a larger trend in the health industry of plans moving into a retail environment. It will also use the space to host wellness classes and events.
Residents of the Villages won't be required to sign up for the new Medicare Advantage plan. They can stay in the traditional Medicare program, with their benefits administered by the federal government, or pick another private option.
The hope though is that the new set of clinics — only available to members of the forthcoming health plan — will woo seniors onto the new offering.
"They could enroll in traditional Medicare or a non-UnitedHealth plan, but they won't be seen at these clinics as a result," Sussman says. "The hope is they find this so amazingly attractive that they choose this model over anything else that's available."
KLIFF NOTES: Top health policy reads from around the Web.
The final regulation on essential health benefits is out. "The new regulations also close a major gap in coverage for people suffering from mental health or drug problems. Prior to the rule, almost 20 percent of people purchasing insurance did not have access to mental health services, and nearly a third had no substance abuse disorder benefits, the agency said." Ben Goad in the Hill.
Universal Orlando will end its "mini-med" plans for part-time employees. "Universal's plan costs about $18 a week for employee-only coverage but covers only a maximum of $5,000 a year toward hospital stays. There are similar caps for other services. Universal is one of the largest employers in Central Florida, with approximately 17,000 employees. It has thousands of part-time workers, though Universal said only about 500 of them are enrolled in the current insurance plan, as many part-timers are covered by a parent's or spouse's insurance." Jason Garcia in the Orlando Sentinel.
How the sequester effects health care. "The Food and Drug Administration would be able to do fewer drug approvals and conduct 2,100 fewer inspections at domestic and foreign facilities that manufacture food products. Cuts to the Mental Health Block Grant program would mean that 373,000 adults and children would not receive mental health services." Mary Agnes Carey in Kaiser Health News.