Ask the expert: Matt Aug on Medicare Advantage

Cox HealthPlans launched its CoxHealth Medicare Advantage product earlier this year to provide locally based coverage for Medicare-eligible members of the communities we serve.

The program offers the benefits of Medicare, with a variety of additional benefits administered by Cox HealthPlans. In addition, Cox HealthPlans is the only Medicare advantage plan provider with local offices and locally based member-support services.

Medicare advantage plans are a growth area for insurance carriers, and Cox HealthPlans’ affiliation with CoxHealth is key to providing high-quality, efficient care for our region’s senior population.

The plan currently serves approximately 4,000 members, and it continues to expand. We sat down with Cox HealthPlans President Matt Aug to talk about how Cox HealthPlans is serving our communities. Here is what he had to say:

What made Cox HealthPlans launch a Medicare advantage product?

As the only locally based health insurance company in our region, we are always looking for ways to grow our business and be able to serve more people in our community.

We know that Medicare advantage plans and plans that serve the Affordable Care Act marketplace are both areas of growth for insurers as the need for those plans increases.

Our area has a large population of senior citizens, and working to serve that population with a dedicated product is a natural fit.

Senior citizens typically have a strong relationship with their primary care physician, as well as ongoing relationships with a stable team of specialists. So, offering a plan that offers access to our teams at CoxHealth is a benefit both for patients, and for CoxHealth as a whole.

The plan is an HMO network, and it includes CoxHealth-employed physicians, as well as many independent providers. If patients need a referral, we are able to refer to Barnes Jewish and Washington University. We are able to offer on-site member service representatives that provide a high level of service to our senior population.

We have worked to create the best plan we can, and to offer the most comprehensive set of options for the community.

What are the business benefits of Cox HealthPlans’ affiliation with CoxHealth?

Ultimately, the collaboration with CoxHealth and Cox Medical Group benefits all parties, especially the patients we serve.

By working with CoxHealth, we are able to have more transparency and have more real-time data on the care providers are delivering. That is important to operational success, and to having a full view of patients’ overall health.

CoxHealth’s physician leaders directly support the health plan – Dr. Julia Flax is the medical director for our Medicare Advantage product, and other physicians serve on committees related to this line of business.

When we work together operationally, we become more efficient, and can offer more benefits for our patient population.

How does the affiliation benefit patients?

We are able to have much greater collaborative visibility to data, which allows us to take a “population health”-based approach that considers the big picture of a patient’s care. We are able to be more proactive and support preventive care. For example, having centralized medical and utilization records allow us to send reminders to patients who haven’t come in for a checkup recently.

We are also able to work directly with CoxHealth providers and other CoxHealth colleagues to help patients when they have questions or need assistance. That kind of support is especially important with a high-risk senior population.

It may seem unusual for a health plan to be affiliated with a health system – how does that work with an offering like Medicare Advantage?

That’s a good question. While this product is new, Cox HealthPlans has been here for 27 years, serving patients and working with CoxHealth.

These plans follow the Centers for Medicare and Medicaid Services’ strict, prescriptive rules for Medicare advantage plans.

CMS is very focused on seeing the whole picture of a patient’s care – understanding their risk and making sure health systems are providing high quality care. These plans are ideal for helping deliver preventive care and follow-up care, in addition to any acute interventions a patient may need.

We report claims and pharmacy information to CMS and our affiliation with CoxHealth helps us analyze utilization patterns and quality data.

We are working to create efficiency throughout the plan. We are excited to bring value to our community and to the health system. If we can support the best care and bring value to our community, we all win.