Medicaid, healthcare reform
On the heels of the Supreme Court’s healthcare reform ruling, WellPoint’s planned acquisition of Amerigroup shook up the healthcare market. The move also brought a previous WellPoint purchase into better focus.
In 2011, WellPoint bought CareMore Health Plans, a small but innovative Medicare Advantage plan. CareMore championed medical homes and aggressive coordinated care for Medicare beneficiaries at several dozen care centers in California, Arizona and Nevada. CareMore emphasizes primary and preventive care to treat its members. With 14 for-profit Blue plans, most of which are top players in their respective markets, the CareMore purchase positioned WellPoint for a Medicaid expansion. The carrier plans to open a dozen new CareMore facilities this year, many in new markets.
With the Amerigroup purchase, there is no mystery about where WellPoint will generate the additional Medicaid and Medicare business. Looking at the two plans, the potential synergy is immense. Paired with CareMore’s medical home focus, Amerigroup could become a market leader in care for dualeligibles or Medicaid members with complicated health conditions. With the industry’s attention concentrated on expenses for dualeligible care, WellPoint can leverage two plans’ abilities to serve that population.
Amerigroup has ample experience with special needs plans for dual-eligibles. CareMore’s SNP slate is more expansive, with plans tailored to COPD, diabetes, cardiovascular disease and beneficiaries in institutional settings.
The synergies could be immediate in markets where the plans already overlap. One is inNevada, where all three have a presence. CareMore centers operate in Las Vegas, Amerigroup has more than 80,000 Medicaid members, and Anthem Blue Cross and Blue Shield in Nevada has more than 107,000 commercial members. Ironically, Amerigroup entered Nevada Medicaid after Anthem chose to depart the program and divest itself of those members.
Even in states that have no intentions of expanding Medicaid, the opportunities are myriad. In state like Texas, Amerigroup’s largest Medicaid state by enrollment, CareMore clinics could provide a nexus of care for members in STAR-PLUS, Texas Medicaid’s managed care program for the aged, blind and disabled. With less than one-third of Texas physicians seeing new Medicaid patients, a few CareMore centers could go a long way.
In the Medicare market, it also gives WellPoint space to compete with UnitedHealth Group, which added XL Health, a Medicare Advantage plan that specialized in chronic care. The scope of Amerigroup and the care coordination skills of CareMore will make WellPoint a formidable challenger for Medicaid business and Medicare market share.
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