Villages Healthcare joining forces with United Healthcare

[Villages PL]

In the beginning, we were told that The Villages Health Care system was going to be very different. It was going to revolutionize health care and be the model that the rest of the world would follow - the "Marcus Welby" approach.

In yesterday's Daily Sun (Feb. 23, 2013), there was an article: "Villages continues to make health care top priority". (This was on the front page of section C) In this article, the big news is that The Villages Health Care is joining forces with United Healthcare. United Healthcare owns and operates Medicare Advantage plans like Prefered Care Partners, of which I am a member.

The relationship, as the article pointed out, has the potential to deliver high-quality and cost-effective care. It seems like The Villages Healthcare system is going to be run like a Medicare Advantage Plan in that it may adopt many of the same operating procedures. Is that a fair assumption?

Draw your own conclusions but it no longer sounds like what I described in my first first paragraph. Could this article have been their way of breaking the news slowly that the villages Healthcare may end up being another Medicare Advantage Plan? Is it possible, or likely, that United is overseeing the development and then may eventually buy out the developer and turn it into a Medicare Advantage Plan?

[Mack184]

TVRH is owned & operated by The Central Florida Health Alliance. All this means is that they are making United Healthcare one of their "primary affiliations" which usually allows those who are on one those UH plans less co-pay. It does NOT change the policy or operation of the hospital. It just means that they are accepting the UH plans as a preferred member. Again that usually means some lower costs for plan members. In a sense it's sort of like a retailer choosing to now accept American Express as well as Visa & Master Card.

You are obviously old enough to not be taken in by those immortal words.."In order to serve you better..." All that ever means is that they are doing something that will benefit them more than it will you.

Hospital policy & practices are still going to be decided and administered by their owners The Central Florida Health Alliance.

Cheers.

[graciegirl]

,,,

[skyguy79]

Does what has been stated have any validity, or does it just provide an opportunity for more rumors to be created? In all honesty I don't know. However, what I can state is that my wife and I are now members of the Villages Health Care System, I have Medicare as primary and the New York State Empire Plan as secondary where medical care coverage is handled by UnitedHealthCare for the Empire Plan. I see nothing different now with my coverage from what it's been with any other provider I've had since moving here from NY. Same primary, same secondary and the VHCS has nothing to do with either of them except to file any covered claims with them for me.

[Mack184]

Does what has been stated have any validity, or does it just provide an opportunity for more rumors to be created? In all honesty I don't know. However, what I can state is that my wife and I are now members of the Villages Health Care System, I have Medicare as primary and the New York State Empire Plan as secondary where medical care coverage is handled by UnitedHealthCare for the Empire Plan. I see nothing different now with my coverage from what it's been with any other provider I've had since moving here from NY. Same primary, same secondary and the VHCS has nothing to do with either of them except to file any covered claims with them for me.
That's exactly the way it works. However, I'm sure that if you researched your NYS plan (Are you a Tier-1??) there are certain "preferred providers" that will give you a deal if you use their services. Most plans have a preferred provider schedule, and usually that means that if you go to a certain doc or a certain hospital often there will be a smaller co-pay or in some cases the doc or hospital will accept whatever the plan will pay with no additional expense to you. This looks like what's happening here with United Healthcare & TVRH. If so, then it will be a help to those who have UHC plans. Doesn't do anything for anybody else. And they are certainly not dictating operations to Central Florida Health Alliance.

The OP said they were happy with their UHC plan. I was under an employer UHC plan at one time in NYS, and it was positively the worst health insurance that I ever had, ever, anywhere. However, I don't know if that was UHC's SOP or simply the plan that the employer had bought.

[skyguy79]

That's exactly the way it works. However, I'm sure that if you researched your NYS plan (Are you a Tier-1??) there are certain "preferred providers" that will give you a deal if you use their services. Most plans have a preferred provider schedule, and usually that means that if you go to a certain doc or a certain hospital often there will be a smaller co-pay or in some cases the doc or hospital will accept whatever the plan will pay with no additional expense to you. This looks like what's happening here with United Healthcare & TVRH. If so, then it will be a help to those who have UHC plans. Doesn't do anything for anybody else. And they are certainly not dictating operations to Central Florida Health Alliance.

The OP said they were happy with their UHC plan. I was under an employer UHC plan at one time in NYS, and it was positively the worst health insurance that I ever had, ever, anywhere. However, I don't know if that was UHC's SOP or simply the plan that the employer had bought.I believe I understand what you're saying, however moving away from NY to FL (or any other state) we only had one choice, Empire Plan and no options. I have no complaints though! If we stayed in NY then there are other plans and/or options we could have selected. BTW, I am tier 1!

[Villages Kahuna]

I thought that TVRH was the hospital, which is owned by the Central Florida Health Alliance. The new Villages Health System is the new collection of eight large primary care offices being built in The Villages.

I'm not totally certain, but I don't think TVHS is owned by the hospital or Central Florida Health Alliance. For the moment, isn't TVHS owned by either the developer or the developer and the doctors who choose to join TVHS? For sure the developer owns the beautiful offices they will occupy. (Have you been inside the newly opened TVHS office at Colony Cottage? Wow! Double wow!)

So who's signed up with United Healthcare? TVRH or TVHS? From all that was announced about the new "Marcus Welby" approach by TVHS, the suggestion was that it will eventually be owned and operated much like The Mayo Clinic, The Cleveland Clinic, and other such organizations that do not practice fee for service medicine.

Am I missing something?

[Tellmeyourstory....]

In the beginning, we were told that The Villages Health Care system was going to be very different. It was going to revolutionize health care and be the model that the rest of the world would follow - the "Marcus Welby" approach.

In yesterday's Daily Sun (Feb. 23, 2013), there was an article: "Villages continues to make health care top priority". (This was on the front page of section C) In this article, the big news is that The Villages Health Care is joining forces with United Healthcare. United Healthcare owns and operates Medicare Advantage plans like Prefered Care Partners, of which I am a member.

The relationship, as the article pointed out, has the potential to deliver high-quality and cost-effective care. It seems like The Villages Healthcare system is going to be run like a Medicare Advantage Plan in that it may adopt many of the same operating procedures. Is that a fair assumption?

Draw your own conclusions but it no longer sounds like what I described in my first first paragraph. Could this article have been their way of breaking the news slowly that the villages Healthcare may end up being another Medicare Advantage Plan? Is it possible, or likely, that United is overseeing the development and then may eventually buy out the developer and turn it into a Medicare Advantage Plan?

You are on the right track! I am also told that my insurance agent in The Villages can not sell any preferred car partners or any United HealthCare products because they are creating their own through UHC....

[ilovetv]

I thought that TVRH was the hospital, which is owned by the Central Florida Health Alliance. The new Villages Health System is the new collection of eight large primary care offices being built in The Villages. ........ From all that was announced about the new "Marcus Welby" approach by TVHS, the suggestion was that it will eventually be owned and operated much like The Mayo Clinic, The Cleveland Clinic, and other such organizations that do not practice fee for service medicine.

Am I missing something?

I don't think most of us really know what it means to run a healthcare system the way Mayo Clinic or Cleveland Clinic do. It is quite a stretch of the imagination to say that paying doctors a salary instead of fee-for-service payments would make a small system like TV Healthcare "like Mayo or Cleveland Clinic".

Those two huge, historic institutions are world-class giants among the many teaching hospitals in the country, in which medical school graduates do their required residency training and subspecialty training to be able to practice on their own. Here are two articles among many that explain key features of Mayo or Cleveland Clinic etc.

Mayo School of Graduate Medical Education:

2011-2012 fact sheet

The Learning Community

144 Categorical Internal Medicine Residents; 24 Preliminary Residents
4 Chief Medical Residents
92 medical schools represented
80-100 Mayo Medical Students and 50 Visiting Student Clerks per year
~2,940 Mayo Clinic Rochester residents, fellows and students
˜2,060 Mayo Clinic Rochester staff physicians and scientists
More than 600 Mayo Clinic Rochester Internal Medicine Faculty (no private attendings)

Patient base and care environment

- On a typical day more than 5,700 outpatient visits at Mayo Clinic Rochester, or more than 1.5 million outpatient visits/year.
- More than 2,000 hospital beds; ˜240 daily hospital admissions.
- ˜ 80 percent of patients are from Minnesota, Iowa or Wisconsin.
- In 2011, Mayo Clinic provided over $62 million for charity care and care to those in need.
- Mayo Clinic Rochester's two hospitals, Emergency Department and Clinic buildings are all within walking distance.
- Industry leader for electronic medical record, which includes online x-ray viewing.
- Multiple divisions ranked in the 2011, U.S. News and World Report "National Top 10 Specialty Rankings".
#1 - GI
#1 - Endocrinology
#1 - Nephrology
#2 - Cardiology
#2 - Neurology
#2 - Pulmonary
#4 - Oncology
#4 - Rheumatology
#6 - Geriatrics......
Highlights - Internal Medicine Residency MN - Mayo Clinic (http://www.mayo.edu/msgme/residencies-fellowships/internal-medicine-and-subspecialties/internal-medicine-residency-minnesota/highlights)

What does Medicare have to do with Graduate Medical Education? (Residency Training)

https://www.aamc.org/initiatives/gmefunding/factsheets/253372/medicare-gme.html

[Mack184]

IMHO, Johns Hopkins..Mayo..Cleveland have the FINEST doctors on the planet. For any institution to be at that level requires world-class facilities & world-class medical professionals. To have those assets requires tons and tons and tons and tons of MONEY. Unfortunately, unless the entire design of this area is changed, that is not going to happen. Why? Because the majority of the population here is on Medicare. Between Medicare and the various Medicare "gap" plans that's pretty much the sum & substance of the revenue that TVRH, TVHS & their doctors can count on.

Because of the mandates of the new Affordable Care Act, doctor & hosptial reimbursements from Medicare are being DECREASED. Since TVRH receives the largest amount of per capita Medicare dollars of ANY hospital in the US it is going to put a heavy strain on the hosptial system because they do not have substantial revenue streams from any other source such as private insurance or monies coming from the ACA policies which will begin to be offered in 2014.

In many larger areas..especially those areas served by hospitals like Hopkins, Mayo & Cleveland..a large number of doctors will stop taking Medicare altogether. Within those groups there are those who have stopped taking ANY form of insurance. They are often referred to as "Gucci Doctors". You want a service? You will pay them with cash or plastic and they will provide you with service.

They claim that without having to deal with private insurance or Medicare they can give you more of their time and better service. Maybe so.

But the problem for The Villages "bubble" is not going to change. The majority of the population's insurance coverage is Medicare. A good number of the best & brightest doctors are not going to be accepting Medicare come 2014. Which will leave areas with large 65+ populations to have to settle for lesser doctors and facilities because of the decrease in Medicare reimbursements by the Feds. That's NOT a recipe for the kind of world-class care that's found at Hopkins, Mayo or Cleveland.

[RedChariot]

,,,

What does this mean? I have seen it before.

[Villages PL]

I thought that TVRH was the hospital, which is owned by the Central Florida Health Alliance. The new Villages Health System is the new collection of eight large primary care offices being built in The Villages.

I'm not totally certain, but I don't think TVHS is owned by the hospital or Central Florida Health Alliance. For the moment, isn't TVHS owned by either the developer or the developer and the doctors who choose to join TVHS? For sure the developer owns the beautiful offices they will occupy. (Have you been inside the newly opened TVHS office at Colony Cottage? Wow! Double wow!)

So who's signed up with United Healthcare? TVRH or TVHS? From all that was announced about the new "Marcus Welby" approach by TVHS, the suggestion was that it will eventually be owned and operated much like The Mayo Clinic, The Cleveland Clinic, and other such organizations that do not practice fee for service medicine.

Am I missing something?

Thanks, I don't think you're missing anything at all. I'm really puzzled as to why TVRH was brought into this conversation in the first place. The article that I referred to did not mention TVRH. Did anyone actually read the article?

[2BNTV]

I have UHC Medicare Complete in CT which is a medical advantage plan that inludes drug coverage. I plan to keep it when I move to TV as I understand the plan in FL is slightly better. I find this plan suits my needs as I am fairly healthy and don't require frequent visits to the doctor.

Medical Advantage plans are good for people who are relatively healthy and don't require frequent visits to the doctor. I know some people are going to flame me as they have had an emergency situation that requires a supplement coverage. A suuplement is good for those who want piece if mind and not worry about any co-payments. When the next enrollment comes around, I plan to renew it.

IMHO - UHC is one of the better carriers.

[Bizdoc]

DW and I signed up for the Colony clinic. After we did all of the paperwork, we were given a choice of doctors and picked the one that looked like the best fit for us. We had initial appointments with him and are quite happy with the care. She injured her foot last Thursday night and a call on Friday am got her in within a couple of hours to see the doctor.

If you go to their website, you'll see a long list of insurance carriers for which they are a preferred provider. We took my health insurance into retirement (Blue Cross) and will continue it as secondary after we start Medicare.

While I suspect that UHC and the Villages Health may have a "special partnership", no provider in their right mind will stop accepting assignment for the major healthcare plans. And I have no doubt that part of the rationale for the new clinics is the incentives for "accountable care organizations." But then again, I haven't seen any criticism for other companies accepting incentives/credits. Simply smart business. And don't ever kid yourself, *all* hospitals, clinics, medical practices, etc are businesses. They exist to make money. (If you have not read the recent Time cover article on health care costs, you should). If they make a big deal of talking about how they are a charitable organization, firmly grip your wallet - they will make a play for it.

Ask youself why we are such a desireable demographic? Statistically, we will require more health care than younger folks. And the folks who live in the villages are likely to be affluent enough to supplemental insurance cover.

And what's the best hospital/medical center in the country? For my money, it is Duke. DW has had 4 surgeries there and the care (from the perspective of a former hospital administrator at a Harvard teaching hospital) is the best that either of us has seen (insluding Hopkins and Mass General.)

Of course, we could be wrong. We are, after all, getting forgetful in old age...

[Villages PL]

In the beginning, we were told that The Villages Health Care system was going to be very different. It was going to revolutionize health care and be the model that the rest of the world would follow - the "Marcus Welby" approach.

In yesterday's Daily Sun (Feb. 23, 2013), there was an article: "Villages continues to make health care top priority". (This was on the front page of section C) In this article, the big news is that The Villages Health Care is joining forces with United Healthcare. United Healthcare owns and operates Medicare Advantage plans like Prefered Care Partners, of which I am a member.

The relationship, as the article pointed out, has the potential to deliver high-quality and cost-effective care. It seems like The Villages Healthcare system is going to be run like a Medicare Advantage Plan in that it may adopt many of the same operating procedures. Is that a fair assumption?

Draw your own conclusions but it no longer sounds like what I described in my first first paragraph. Could this article have been their way of breaking the news slowly that the villages Healthcare may end up being another Medicare Advantage Plan? Is it possible, or likely, that United is overseeing the development and then may eventually buy out the developer and turn it into a Medicare Advantage Plan?

Just a reminder of what this thread is about.

[sharonga]

I believe I understand what you're saying, however moving away from NY to FL (or any other state) we only had one choice, Empire Plan and no options. I have no complaints though! If we stayed in NY then there are other plans and/or options we could have selected. BTW, I am tier 1!

Hi, I am Tier 4. Have you found a dentist that works with the UFT?

[skyguy79]

Hi, I am Tier 4. Have you found a dentist that works with the UFT?Sorry, don't have dental. Didn't know what UFT was until now, but that's because neither of us were members of the teachers union. I am CSEA and my wife is PEF. Can you contact the UFT Union and see if they have a list of participating providers? You just might have to pay up front and file yourself afterward.

[StarbuckSammy]

Bizdoc...colony clinic will not accept BlueCross once you hit 65. At least that is what I read on their web site...only United.