Expanding Medicare Advantage to Rural Minnesota: Challenges and Opportunities

1. Expanding Medicare Advantage to Rural Minnesota: Challenges and Opportunities Nancy Feldman, CEO, UCare Minnesota Minnesota Rural Health Conference 2005 Duluth, Minnesota July 19, 2005

2. 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.

3. 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.

4. Licensed Service AreaJuly 2005 - 77 Counties 9

5. 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.

9. 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.

10. Medicare Advantage: Opportunities

11. 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.

12. 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

13. Opportunities for Consumers: Value Equation • Incentives for healthy behavior • Mammography outreach • Healthy lifestyle and fitness • Programming targeted at chronic disease • Talking scales • Falls prevention

14. 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.

15. 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.

16. 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

17. 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.