A good value for supplemental plan

Linda Bryant Smith wrote a recent column urging readers to carefully check the details of Medicare Advantage. As an Everett Clinic physician providing care to older patients, I agree patients should select a plan that best meets their needs. This requires a thorough evaluation of the benefits and costs associated with each option. Not all plans are equal and some, particularly the private fee-for-service plans, need to be changed or even eliminated.

However, our experience shows that many of the managed Medicare Advantage programs (HMO/PPO) provide an outstanding value for the patient and reduce health care costs.

Traditional (original) Medicare and private fee-for-service plans pay only if someone actually gets sick. Providers are reimbursed based on the amount of care they deliver, not on the quality of the care. This is a recipe for higher costs and sicker patients. The managed Medicare Advantage programs that we accept at The Everett Clinic help address this deficiency because they focus on prevention and disease management.

The Everett Clinic is one of 10 participants in a national demonstration project for Medicare. Our experience has shown that coordinated care, emphasizing prevention and disease management, actually saves money for Medicare and ensures better care for patients. In the first two years of the project we saved Medicare and patients nearly $2 million and achieved a high clinical quality score of 96 percent.

Patients should indeed evaluate their options carefully and check with their providers, but the bottom line is that managed Medicare Advantage programs are a very good option for many people. They offer a focus on increased prevention, disease management and coordinated care and will save money in the long run, for patients and for taxpayers.

Todd Gunderson, M.D.

Everett