In the late 1980’s I was the marketing manager for a for-profit HMO that bilked seniors. Once I learned that I left. But it took about a year. That work, however, fueled me to be an ardent patient/consumer advocate. Please read this blog this and share it.
Medicare Advantage Plans became law the same year as the Medicare Pharmaceutical benefit in 2003. Medicare is prohibited from negotiating rates with pharmaceutical companies. The VA is not. More on this later, but for now private Medicare Advantage programs and Medicare.
THEN——“Cut off: HMOs trim elderly for profit” (July 30, 2000) The Seattle Times
….“Medicare HMOs are the canary in the coal mine. As Medicare goes, so goes the nation. Because of its size and influence, whatever it does will be copied by the commercial plans that follow the path of least resistance.
“And, don’t listen to anyone who says, “who’s going to pay for it?” We are all paying for it now. Just ask any senior who has to change plans. Unless and until we say what we want – a system that supports the health and well-being of our seniors and the health and well-being of our communities and our nation, then we will remain stuck with a crippled system that is more concerned about cash than care.” …. (Emphasis mine)
http://www.oconnorreport.com/old/pgs/hmo.html From The Seattle Times
AND NOW—–“Former Rep. Allyson Schwartz’s new group, The Better Medicare Alliance, is not what it appears” (April 27, 2015) Public Integrity
….“Insurers that participate in the Medicare Advantage program devote big chunks of their advertising and sales budgets to lure seniors away from the traditional Medicare program, which costs taxpayers less. For many seniors, the marketing is irresistible. Enrollment in Medicare Advantage plans jumped 10 percent between 2013 and 2014. Thirty percent of Medicare’s 54 million beneficiaries are now in a Medicare Advantage plan.
“Insurers insist that Medicare Advantage plans represent a good value for seniors and the country. They say, for example, that because of the managed care techniques they use, they are better able to coordinate care for seniors with chronic conditions.
“A downside rarely mentioned is that many doctors and health care facilities, including nursing homes, refuse to participate in Medicare Advantage provider networks. Other providers that might want to participate are often excluded. My own mother didn’t fully appreciate the consequences of her Medicare Advantage plan’s limited network until recently. She decided to switch back to traditional Medicare so she could go to a nursing home of her choice with high quality ratings” …. (Emphasis mine)
This has to stop! I am off to a conference for the day, but I wanted to get this out. Please share widely. I will write more on this later.
Kathleen O’Connor (c) April 28, 2015