HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, finds that the short time given by the Centers for Medicare and Medicaid Services (CMS) to implement Medicare insurance products across multi-state regions made it difficult for health plans to pull provider networks together. According to the latest issue of New England Health Plan Analysis from HealthLeaders- InterStudy, Fallon Community Health Plan and Blue Cross Blue Shield of Massachusetts will be offering local Medicare PPOs within the state of Massachusetts.
"To operate in one of the new Medicare Advantage regions set up by CMS, you need to pull together a network across a number of states," said Ric Gross, HealthLeaders-InterStudy analyst. "New England is largely rural, and that would require an immense effort contracting with new physicians and hospital systems. No one has taken that plunge yet."
Fallon's Senior Preferred product went live July 1, 2005. Blue Cross Blue Shield's product will be available September 1. Massachusetts is an HMO stronghold, and these less-restrictive Medicare PPO products are the first available to seniors in the state.
Other health plan news in New England: * While all New England health plans showed a profit in 2004, only in Vermont did HMOs as a whole make more money in 2004 than they did in 2003. * Maine's first pharmacy mail-order distribution system -- run by the Penobscot Indian Nation -- is set to become operational by September 2005. * Harvard Pilgrim Health Care has launched its first product tying a health savings account (HSA) to a high-deductible PPO. About HealthLeaders-InterStudy
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