MA Secure Horizons Evercare. Being Dropped

[luke4275]

I cold called a man and he said he received a letter saying that his evercare plan is going to be dropped and he should call and they will put him in another plan. He pays $25 per month.. I know this is an opp for me but not sure what and when to offer an alternative. I didnt meet with him I only heard what he said.. this is in CA. has anyone else heard about this plan being dropped? what would you replace it with? thanks

 

[Norwayguy]

I cold called a man and he said he received a letter saying that his evercare plan is going to be dropped and he should call and they will put him in another plan. He pays $25 per month.. I know this is an opp for me but not sure what and when to offer an alternative. I didnt meet with him I only heard what he said.. this is in CA. has anyone else heard about this plan being dropped? what would you replace it with? thanks

Quick question, How is this an opportunity for you? Based on your post the opportunity would have to be a SNP and how where you cold calling for the sale of CMS regulated products?

 

[luke4275]

I was calling for med supps and he mentioned the plan he was on and what was happening to it..

 

[GreenSky]

UHC is apparently dropping or at least restricting the Evercare Chronic SNP.

Rick

 

[wehotex]

I cold called a man and he said he received a letter saying that his evercare plan is going to be dropped and he should call and they will put him in another plan. He pays $25 per month.. I know this is an opp for me but not sure what and when to offer an alternative. I didnt meet with him I only heard what he said.. this is in CA. has anyone else heard about this plan being dropped? what would you replace it with? thanks

which part of calif? are there no more options where this client lives?

 

[Josh]

UHC is apparently dropping or at least restricting the Evercare Chronic SNP.

Rick

Which may have something to do with CMS actually setting guidelines, standards, and expectations for what these plans have to do with the extra reimbursements.

"You mean we have to actually use the extra money to provide more care?"

To oversimplify it, the carriers are going to have to actually provide a medical management team with specific guidelines now rather than just saying "Oh, you have diabetes, that's a chronic condition, here's a better plan" which then resulted in the carrier getting a higher reimbursement which they did not use to provide the member a level of care that was above the average standards enough for CMS to feel as though they were "getting their moneys worth" out of it. More details are here: Overview Special Needs Plans

Many of the carriers had been doing this because they thought it was going to be relatively easy money, but the costs are higher than they had anticipated and now that there will be a scoring system that they will be held to you may see many carriers stepping back from it. This has typically been a huge market for UHC.

 

[wehotex]

Which may have something to do with CMS actually setting guidelines, standards, and expectations for what these plans have to do with the extra reimbursements.

"You mean we have to actually use the extra money to provide more care?"

To oversimplify it, the carriers are going to have to actually provide a medical management team with specific guidelines now rather than just saying "Oh, you have diabetes, that's a chronic condition, here's a better plan" which then resulted in the carrier getting a higher reimbursement which they did not use to provide the member a level of care that was above the average standards enough for CMS to feel as though they were "getting their moneys worth" out of it. More details are here: Overview Special Needs Plans

Many of the carriers had been doing this because they thought it was going to be relatively easy money, but the costs are higher than they had anticipated and now that there will be a scoring system that they will be held to you may see many carriers stepping back from it. This has typically been a huge market for UHC.

that's a very good analogy of what these companies have been doing all of these years. even though it's affecting my pocketbook, I am glad to see at least one part of the Federal gov't trying to get its money's worth from these companies who have been fat and sassy for so long.

I've noticed that UHC has proposed migration of all its chronic illness programs into its standard plan in Texas, San Antonio being the lone exception. The dominant medical group in San antonio invests a lot of $$ in disease management programs and pretty much gets what it demands out of UHC every year.

 

[medx]

I cold called a man and he said he received a letter saying that his evercare plan is going to be dropped and he should call and they will put him in another plan. He pays $25 per month.. I know this is an opp for me but not sure what and when to offer an alternative. I didnt meet with him I only heard what he said.. this is in CA. has anyone else heard about this plan being dropped? what would you replace it with? thanks

Thanks for the info.

 

[420 Gimee]

So, will they be dropping the rest of the Secure Horizon plans?