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Expanding Medicare Advantage to Rural Minnesota: Challenges and Opportunities. Nancy Feldman, CEO, UCare Minnesota Minnesota Rural Health Conference 2005 Duluth, Minnesota July 19, 2005. UCare Minnesota. One of Minnesota’s leading HMOs.

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Expanding Medicare Advantage to Rural Minnesota: Challenges and Opportunities

Nancy Feldman, CEO, UCare Minnesota

Minnesota Rural Health Conference 2005

Duluth, Minnesota

July 19, 2005


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UCare Minnesota

  • One of Minnesota’s leading HMOs.

  • Over 20 years experience improving and maintaining the health of Minnesotans.

  • Minnesota-based.

  • Provides coverage and services for 130,000+ Minnesotans.


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UCare, Rural Minnesota and Medicare

  • Operating in rural Minnesota since 1996.

  • In Medicare managed care since 1998.

  • As of 7/1/05, UCare offering Medicare Advantage in 64 counties.

  • As of 1/1/06 UCare expanding Minnesota Senior Health Options.


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Licensed Service AreaJuly 2005 - 77 Counties

9


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Health challenges in rural areas

  • General rural challenges include:

    • Higher prevalence of chronic disease – related to aging of population.

    • Lower incomes.

    • More risky behaviors like smoking.

    • Clinical and social supports may be less accessible.


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Medicare managed care and rural Minnesota

  • Rural Medicare managed care has a mixed history.

  • Medicare Plus Choice did not work for rural Minnesota.

  • 2003 Medicare Modernization Act made it feasible and affordable.

  • Creating great Medicare products for rural seniors is a UCare priority.



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Opportunities for consumers

  • More comprehensive, more affordable coverage and care = better value.

  • Emphasis on prevention and wellness.

  • For those with chronic illness, the program offers care coordination and disease management.

  • Less paperwork.


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Opportunities for Consumers: Value Equation

“Medicare Advantage managed care plans represent a better value for most Medicare beneficiaries than Medigap supplemental insurance…Most Medicare beneficiaries can expect a 50% savings or more in their annual out-of-pocket costs…”

--HealthMetrix Research Inc.

  • Visit www.hmos4seniors.com for cost/value comparisons


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Opportunities for Consumers: Value Equation

  • Incentives for healthy behavior

    • Mammography outreach

    • Healthy lifestyle and fitness

  • Programming targeted at chronic disease

    • Talking scales

    • Falls prevention


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Opportunities for providers

  • Access to quality improvement programs and incentives.

  • Coordination with case management and disease management programs.

  • Support for training.

  • Working (in UCare’s case) with a small, rural-friendly organization.


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Medicare Advantage: Financial Challenges

  • Payment mechanism for Critical Access Hospitals: prospective vs. cost-based.

  • UCare is working closely with CAHs to develop payment mechanism that works for them.

  • UCare is committed to making the financial end of Medicare Advantage work, for consumers and providers.


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Medicare Advantage: Challenges for Consumers

  • New Medicare Advantage options + Medicare prescription drug options + information overload = consumer confusion.

  • Simplify process

  • UCare offering community information sessions on Medicare reform (to date over 4,000 individuals reached).

  • Easy as possible


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Medicare Advantage is a plus for rural seniors.

  • Local plans like UCare recognize that health care is local.

  • Metro-only products with high value now available to rural eligibles.

  • Medicare Advantage is about keeping seniors healthy. Rural seniors deserve it!

  • Medicare Advantage is here to stay.