The Everett Clinic axing some Medicare plans

About 1,400 seniors treated at facilities of The Everett Clinic are being asked to switch to a new kind of Medicare plan by the end of next year if they wish to continue to receive care.

The clinic estimates $7.5 million a year in care for 20,000 Medicare patients isn’t covered by the federal government and instead is subsidized by other patients and insurance, said Rick Cooper, CEO of The Everett Clinic.

To balance the scales, the clinic has changed its policy to steer Medicare Advantage patients to a series of other Medicare plans that better cover the clinic’s costs, he said.

“We made a business decision to move in this direction,” Cooper said. “We have concluded that one of our strategies is to try to encourage our patients to participate in other Medicare Advantage plans because this allows us to almost break even.”

The move has The Everett Clinic proposing to break ties with at least nine plans that allow patients a-la-carte health care choices in doctors and clinics. These plans are paid more money by the federal government, however the additional funding never goes to the clinics or health care providers, Cooper said.

“We want to do business with medical plans that are committed to preventive care, wellness and coordinated care, who believe in directing the majority of the premium to care delivery, and those are the plans we’re going to work with,” Cooper said.

Under the plans favored by the clinic, primary care physicians act as gatekeepers, but also focus on wellness and preventive care, Cooper said. These health plans also pay the clinic more money for patient services.

The clinic’s bottom line might see a $500,000 to $750,000 improvement if the 1,400 patients can be persuaded to shift to other plans.

“Original Medicare” patients, about 60 percent of the clinic’s clients, are unaffected by the change, Cooper said.

Patients have until the end of next year to change plans. Cooper also plans to write to future Medicare patients before their 65th birthdays to steer them away from the subset of Medicare health plans the clinic will no longer honor.

The clinic estimates that the number of Snohomish County seniors over 65 years old will increase at the fastest rate between now and 2011. About 64,000 men and women were in that age bracket in 2006; that number is expected to be more than 78,000 in 2011, Cooper said.

There are a few windows of time to change plans between mid-November and April, and again at the end of next year.

Reporter Jeff Switzer: 425-339-3452 or jswitzer@heraldnet.com.

Free information sessions

Drop-in information sessions for patients of The Everett Clinic are planned in November and December, including time to talk with Medicare Advantage health plan representatives and hear about the policy change from the Everett Clinic leadership. The meetings are planned at the clinic’s conference center at 3830 Hoyt Ave., Everett.

Nov. 28: 10 to 11: 30 a.m.; 5 to 7:30 p.m.; special clinic presentations at 10 a.m., 5 p.m. and 6:30 p.m.

Nov. 30: 10 a.m. to noon; special clinic presentation at 10:30 a.m.

Dec. 12: 10 a.m. to noon; special clinic presentation at 10 a.m.

Plans not accepted by Everett Clinic after Dec. 31, 2008

Advantra Freedom, Aetna Medicare Open Plan, Care Assured, Coventry (First Health), Humana, Secure Horizons by United Healthcare (including Direct Premier Plan 300 and Direct Plan 3), Sterling and Unicare.

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