After unveiling plans earlier this year to enter the Medicare Advantage space in 2019, longtime insurance company Mutual of Omaha on July 17 disclosed that it is preparing to launch the first of its MA products in the greater Cincinnati area. Mutual of Omaha has been working with strategic partner Lumeris, Inc. to identify
potential market entry points and value-based partners, which will include two local health systems in Cincinnati, and tells AIS Health it has applied to offer MA plans next year in at least one other service area.
As a longtime provider of Medicare Supplement and life insurance products, Mutual of Omaha a couple years ago began taking a “serious look” at getting into MA after conducting some internal market research of its senior customers, explains Amber Rinehart, senior vice president of senior health solutions. “We segmented the market into 10 different segments and across all 10 segments it was roughly equal whether people were choosing MA to meet their health care needs or Original Medicare and Med Supp,” she says in an interview with AIS Health. “And as a customer-focused company, we really need to be focused on better meeting the needs of our customers, so we said, ‘If there’s people out there that trust us and like us as a company but we’re not offering the products that they need, we have a huge opportunity,’ so that pushed us over the hump.”
The next question was how to enter the market. Rinehart says Mutual of Omaha looked at a few different options, including renting the networks of some large MA plans to offer a “kind of white label product.” But after a meeting with St. Louis-based Lumeris, which serves as a long-term operating partner to health systems, providers and payers that are focused on making the transition to value-based care, the insurer knew it wanted to move in that direction, she recalls.
As a subsidiary of Essence Group Holding Corp., Lumeris also operates highly rated MA plans under the Essence Healthcare brand, which relies on strong physician engagement and has served as a testing ground for the strategies it shares with partners that are interested in building out a similar model (RMA 4/5/18, p. 1). “It’s trying to drive the waste out of the health care system and provide better outcomes, and it aligns really well culturally with us, and we think it’s really a win-win win, for us, the providers and the customers,” says Rinehart of the model.
Mutual of Omaha earlier this year said it would begin offering MA plans with prescription drug coverage in select markets in 2019, pending CMS approvals, and that the partners will create MA plans across the country under the Mutual of Omaha name (RMA 2/1/18, p. 8). In Cincinnati, two local health care systems — TriHealth and St. Elizabeth Healthcare — will serve as the insurer’s value-based partners and comprise the bulk of the network. Cincinnati-based TriHealth is a unified health system made up of five hospitals; St. Elizabeth operates six facilities throughout Northern Kentucky and more than 115 primary care and specialty office locations in Kentucky, Indiana and Ohio. Mutual and Lumeris will market the plan, manage day-to-day operations and support the optimization of the network.
The new partnership will allow TriHealth to take more risk than it has in previous arrangements through the Health Solutions Network, a clinically integrated network started by TriHealth and St. Elizabeth in 2015. That network has two contracts, one with the Medicare Shared Savings Program and one with a UnitedHealthcare MA plan. “Spearheading” care for the Mutual of Omaha plan will enable the health system partners to provide a “population health-based, value-centered” model in which the resources are aligned to deliver appropriate and high-quality patient care, explains Randall Curnow, M.D., medical director for population health at TriHealth.
Twenty-seven percent of major U.S. health system executives participating in a recent Lumeris survey said they intend to launch an MA plan in the next four years, but only 29% of those respondents felt confident in their organizations’ ability to do so.
The majority of respondents (59%) indicated they were likely to utilize outside resources to launch their plans, such as a vendor partner that can mitigate operational risk.
Providers Will Accept Some Risk
While the fine points of the Mutual of Omaha relationship are still being worked out, Curnow says the goal is “to take progressively more risk.” He adds that TriHealth believes each partner brings “distinct advantages,” such as the physician collaboration across the St. Elizabeth/TriHealth systems, Lumeris’ background in MA plans and clinical transformation, and the market knowledge and resources of Mutual of Omaha. “We think that those together can really make a dynamic impact in our market and [provide] more flexibility…in terms of how we can design the product and meet the needs of our population than a national MA plan would,” says Curnow.
Both providers have their own internal systems and data analytics platforms, but Lumeris will bring in some of its own expertise and resources in order to better identify at-risk populations and engagement strategies for those patients, he adds.
Mutual of Omaha at press time was hoping to sign contracts with CMS in late August and was “heavily getting ready for marketing,” says Rinehart. And the plan is focused on “making sure the providers will be able to answer questions that their patients have so that they can let them know that we’re offering a new product and will probably have some signage in doctors’ offices as well.”
Humana Leads Cincinnati MA Market
She adds that Mutual of Omaha selected Cincinnati because it is a “good-sized market and growing.” According to CMS data, roughly 40% of Medicare-eligible consumers are enrolled in MA plans in Hamilton County, Ohio, and have one of 14 plans to choose from, with Humana Inc. leading the market share. Adding to the potential competition is Bright Health, an MA startup that on July 18 said it planned to enter the Ohio market next year and has partnered with Mercy Health, the largest health system in the state.
“Out of the gate we’re really looking for strong enrollment numbers so that we can build a good quality pool of members for our provider partners to manage, and you need to have adequate membership there to really drive those outcomes and drive out the waste in the system, so [our goal is] really try to hit those enrollment numbers out of the gate and work with our provider partners assisted by the tools and the data from Lumeris to execute well on the value-based care,” says Rinehart.
Contact Curnow and Rinehart via Lisa Chernikoff for Lumeris at firstname.lastname@example.org.
Media / Amendola Communications for Lumeris
Lisa Chernikoff, 734-678-5513