Not-for-profit health system and Medicare Advantage insurance provider seek to expand access to care and coverage, pending regulatory approval
ORANGE, Calif. & SACRAMENTO, Calif.–(BUSINESS WIRE)–Today, Sutter Health, a not-for-profit integrated health care system, and Alignment Healthcare, a Medicare Advantage insurance provider, announced the signing of an agreement that allows the two organizations to work together to offer more health care and insurance coverage options for Medicare-eligible residents in Northern California in 2020, pending regulatory approval.
Alignment has filed an application with the Centers for Medicare & Medicaid Services (CMS) to expand its Northern California service area. If the application is approved, Alignment and Sutter would begin offering new Medicare Advantage plans in the approved counties in October 2019 and members could seek “in-network” care with Sutter-affiliated and aligned physicians and facilities on Jan. 1, 2020.
“Sutter has a long history of launching new and innovative health care solutions for the benefit of patients and our communities,” said Phil Jackson, Sutter’s CEO of Health Plan Products. “This collaboration is designed to introduce new Medicare Advantage plans for eligible individuals and to help them shop for plans, find affordable coverage, and gain access to high-quality health care.”
Medicare Advantage plans are offered by private health insurance companies approved by CMS and must cover everything included in traditional Medicare – hospital costs, doctors’ visits and outpatient care. These plans often include extra benefits like prescription drug coverage, vision, dental and hearing exams. Every year, Medicare enrollees can review their health plan options in October and make changes to coverage beginning the following January.
Managed care delivery models such as Medicare Advantage make it easier for health care providers to coordinate care and practice preventive medicine, avoiding emergency room visits and more costly treatment plans. According to a study by the Boston Consulting Group1, Medicare Advantage patients pay less in out-of-pocket costs than patients in traditional Medicare and, on average:
- Are twice as likely to receive preventive care
- Are half as likely to go to the emergency room
- Go home from the hospital one day earlier
- Are less likely to be readmitted to the hospital after discharge, and
- Use fewer health care services, allowing providers to care for others in need
The Congressional Budget Office estimates that approximately 40 percent of all Medicare beneficiaries will be enrolled in Medicare Advantage plans by 2020.2 Of the approximately 2 million Medicare-eligible residents in Northern California, an estimated 850,000 are currently enrolled in Medicare Advantage plans, according to CMS.
“The collaboration between Sutter Health and Alignment Healthcare is centered on our customers,” said Dawn Maroney, Alignment’s consumer president. “We are coming together to offer Medicare-eligible individuals in Northern California more choice, designing health plan products that will provide access and flexibility for specific population age groups in most of Sutter’s existing service areas in Northern California.”
Founded in 2013, Alignment Healthcare has created a model of health care delivery that combines high-touch care coordination with AVA®, its proprietary command center technology, to improve quality of care and eliminate waste in the care system. The central nervous system of Alignment Healthcare, AVA provides real-time reporting and predictive analytics that allow care specialists to anticipate care, often before it’s even needed. Now serving more than 60,000 members across three states, the Orange, Calif.-based company is supported by industry-leading investors and endorsed by influential parties including former CMS administrators and best-in-class hospital systems and health plans.
“Alignment is thrilled about this relationship with Sutter Health,” said John Kao, Alignment Healthcare founder and CEO. “By working together, we have the opportunity to offer more communities more access to care and implement population health strategies that improve care and lead to better health.”
About Sutter Health
Sutter Health is more than 60,000 people strong thanks to its integrated network of physicians, employees and volunteers. Rooted in Sutter Health’s not-for-profit mission, these team members partner to deliver exceptional care that feels personal. From physician offices to hospitals to outpatient care centers and home services, they proudly support the more than 3 million people in their care—nearly 1 percent of the U.S. population, in one of the most diverse and innovative regions in the world. Sutter team members adopt new technologies, make novel discoveries and embrace creative thinking to help patients and communities achieve their best health. From its street nurse program that provides check-ups for homeless people, to telemedicine-aided specialist consultations, to walk-in care clinics, to smart glass technology, the Sutter Health team goes beyond traditional models to make care more convenient and to nurture and empower people throughout their medical journey. For more information about the Sutter Health network visit: sutterhealth.org | facebook.com/sutterhealth | youtube.com/sutterhealth | twitter.com/sutterhealth.
About Alignment Healthcare
Alignment Healthcare is redefining the business of health care by shifting the focus from payments to people. We’ve created a new model for health care delivery that cuts costs and improves lives by unraveling the inefficiencies of the current system to drive patients, providers and payers toward a common goal of wellness. Harnessing best practices from Medicare Advantage, our innovative data-management technology allows us to commit to caring for seniors and those who need it most: the chronically ill and frail. With offices and care centers across the country, Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options to California residents through Alignment Health Plan, and partners with select health plans in North Carolina and Florida to help deliver better benefits at lower costs. For more information, please visit www.alignmenthealthcare.com.
1 https://www.bcg.com/publications/2013/health-care-payers-providers-alternative-payer-models.aspx
2 https://www.cbo.gov/sites/default/files/cbofiles/attachments/44205-2015-03-Medicare.pdf
Contacts
Alignment Healthcare
Alison Trinidad, 657-218-7730, atrinidad@ahcusa.com
Sutter Health
Sy Neilson, 916-643-1227, neilsor@sutterhealth.org