St. Elizabeth Healthcare, Trihealth spearheading care delivery for new Medicare Advantage plan from Lumeris and Mutual of Omaha


Medicare Advantage plans are but one of the ways in which the healthcare system is inching away from fee-for-service reimbursement schemes and toward value-based care, and new MA plans from Lumeris and Mutual of Omaha will debut in the Cincinnati, Ohio and Tennessee areas due to a partnership between Trihealth and St. Elizabeth Healthcare.

The partnership drew the attention of Lumeris and Mutual of Omaha, who selected that geographic area after whittling their options down from about 10 major metropolitan areas.

Their move has created something of a buzz around St. Elizabeth, as the health system anticipates benefits for both itself and its patients. Patient care is expected to improve, and as more people join the MA plans, costs are expected to go down.

“We did a lot of work with Lumeris and Mutual of Omaha to look at their plan design,” said Lori Ritchey-Baldwin, chief financial officer of St. Elizabeth Healthcare. “Part of that plan design revolves around, ‘How do we reduce the overall cost of care?’ Mutual of Omaha is very invested in reducing that overall cost of care. The share in the cost savings they’ve provided is a pretty good savings for us, but of course we have to meet that cost reduction.”

The system expects to lower costs by rising to the challenge of managing care not only in sickness, but in health. In moving to value, the MA plans will help St. Elizabeth monitor patient health outside of the clinical setting, and entice them to come in more consistently for their annual wellness visits so clinicians can address any health issues early on, before they become major headaches.

The MA plans are expected to kickstart on January 1, 2019, and will usher in a new era in the region focused on preventative care — what Ritchey-Baldwin called “the care continuum.” That, she said, will make it easier for the system to fulfill its mission of top-notch patient care.

While St. Elizabeth is confident that savings will be achieved by spearheading the MA plans, exactly how robust the savings will be depend largely on how many Medicare beneficiaries opt for the new plans. But because of their ease and simplicity, the short history of these plans indicates that patients will start migrating toward them.

“More and more traditional Medicare patients are moving toward MA plans,” said Ritchey-Baldwin. “The trend for participation is going to continue to increase. About 10,000 people a day enter into Medicare, and MA plans are much simpler for the participants to understand.”

Though every region of the country is moving toward value at its own pace, the transition is inevitable, said Ritchey-Baldwin, adding that providers need to work together when it comes to things like care coordination and post-acute care. Investments have to be made in things like data, which helps identify patients in need of care before they’re resigned to visiting the emergency room for a can’t-wait ailment.

Ritchey-Baldwin said the partnership with Trihealth is what will ultimately make the launch successful.

“More and more traditional Medicare patients will enroll in MA plans, and that’s why it’s important to have good partners,” she said. “We have to make sure we understand how MA plans work, which we do, and make sure we have partners who are working toward the same things.”