The Villages Health - Grandfathered?!
 

Grandfathered? Think again. If you have Medicare Original get ready to be "porked". Beginning January 1, 2017 you either switch to United Healthcare Medicare Advantage Plan or seek care elsewhere. They will tell you that it is to improve the quality of care, but it has only to do with increasing the quantity of money! They are sucking a lot of red ink due to the quality of their top management staff.

That and the fact that their physicians have a very low case load which was the initial promise of the model.


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Where did you get your information?

The Villages Health - Grandfathered?!
 

I have been following their system since before doc recruiting began. If you research the initial PR, you'll find that the system was built upon the premise of significantly decreasing a physician's caseload when compared to avg caseloads of physicians in "normal" practices.

Here is one article. There are others that include more specific information, but you should get the point from this 2012 article.

http://villages.health.usf.edu/articles/release1.pdf

I should also note I know about the individual who was recruited to form the practices.



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Yes, where did you hear this? What is your source? I have contacted SHINE to see if they have any info on this.

".....Impossible Burden For The Elderly And The Disabled

About half the cost of the ACA (Affordable Care Act) is paid for by cuts in Medicare spending and the only practical way those cuts can be made is by reduced fees to providers.

The Medicare actuaries have noted with alarm that Medicare fees to doctors will drop below Medicaid levels in the near future and the combined effect of lower Medicare and Medicaid hospital spending will drive one in seven hospitals from the market in the next five years.

Although the administration talks about making Medicare more efficient, three separate reports by the Congressional Budget Office (CBO) have concluded that the pilot programs and demonstration projects that are supposed to find these efficiencies are not working.

In fact, the only place in Medicare that shows any promise at all is in the Medicare Advantage (MA) program. But the administration is determined to proceed with cuts in MA subsides and appears to be paying no attention whatever to the efficiencies MA entrepreneurs are discovering.

Because no serious budget analyst believes the Medicare spending cuts can withstand the inevitable political backlash and because they don’t believe the pilot programs will work either, both the CBO and the Medicare Trustees are annually publishing “alternative forecasts” in an effort to predict how Congress will cave. But if Congress does cave and restores the previous Medicare spending path, that means that the ACA isn’t paid for; and that, in turn, means large unfunded liabilities stretching out indefinitely into the future and increasing federal debt......"

Six Problems With The ACA That Aren’t Going Away

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How could The Villages do this to us all? I was told as many as 10,000 will be dumped unless we cancel traditional Medicare and go with the United Advantage plan. We that were grandfathered in a while back will be out. You can say it is a rumor, but some are taking the initiative and seeking a new physician before so many are cut loose.
We were at that first meeting when the physical of bellview explained the program. We signed up immediately. We are disappointed.

This will be a new paradigm for the foreseeable future.

When you look in a dictionary, your post will show up as the definition of "bait and switch"

7-15-2015

"Marilyn Tavenner is about to make an unprecedented move: From head of Medicare, to the nation’s top lobbyist for private insurers — in just six months.

Tavenner will succeed Karen Ignagni as the CEO of America’s Heath Insurance Plans, the New York Times reported on Wednesday. Tavenner had served as the administrator of CMS for more than three years, where she was responsible for Medicare, Medicaid, and much of Obamacare’s implementation.....

...“Asked about her priorities, Mr. Tavenner said she wanted to protect Medicare Advantage, the program under which private insurers manage care for more than 30 percent of the 55 million beneficiaries of Medicare.”

There’s a reason why private insurers care so much about Medicare Advantage: It’s arguably their hottest market right now.....

...The resurgence of Medicare Advantage is a stunning turnabout for a program that was supposed to be dead in the water, thanks to the Affordable Care Act....."

Full story:
Forbes Welcome

http://www.nytimes.com/2015/07/16/us...-lobbyist.html

What information have you received from SHINE? Those of you on TOTV who do not want to go with United Advantage or cannot due to pension benefits restrictions, what is your plan?

Best of 2015 AcademyHealth Annual Research Meeting

Higher Incentive Payments in Medicare Advantage's Pay-for-Performance Program Did Not Improve Quality But Did Increase Plan Offerings

Authors
Timothy J. Layton Ph.D.,
Andrew M. Ryan Ph.D.
First published: 9 November 2015

Objective
To evaluate the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration.

Data Sources
Publicly available data from CMS from 2009 to 2014 on Medicare Advantage plan quality ratings, the counties in the service area of each plan, and the benchmarks used to construct plan payments.

Study Design
The Medicare Advantage Quality Bonus Payment Demonstration began in 2012. Under the Demonstration, all Medicare Advantage plans were eligible to receive bonus payments based on plan-level quality scores (star ratings). In some counties, plans were eligible to receive bonus payments that were twice as large as in other counties.....

Conclusions
At great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.

Health Services Research Higher Incentive Payments in Medicare Advantage's Pay-for-Performance Program Did Not Improve Quality But Did Increase Plan Offerings - Layton - 2015 - Health Services Research - Wiley Online Library

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I, too, feel I was welcomed into the system in the hopes of getting me to go with United Health Care. They certainly have a right to make that decision but if that was their plan all along I wish they would have been honest about it to spare me the trouble of switching everything again.

Am I missing something or am I confused? Is this for people under the age of 65?

I was under the impression that I could switch to Original Medicare with a supplement when I needed to. Doesn't TV Health Care take original medicare?

If it doesn't, then I will have to find a doctor that does take original Medicare, outside of TV Health Care system.

right now it's people who are turning 65. they are told they have to switch to the advantage plan. those that do not choose to do so have to find someone else. now, my neighbors who were 65 when they joined when it started are still supposedly grandfathered in. however, I believe the op was saying as of 2017, they will be required to make the same choice. would be best to call and ask them.

As I recall, it was last year that TV Health stopped accepting patients with Original Medicare. Now, according to the OP and the OP is probably right, all the patients with Original Medicare who had been admitted at the start of The Villages Health System will be disenrolled unless they agree to switch to UH Medicare Advantage. It's ironic that the government wanted to get rid of Advantage programs due to their greater cost to Medicare but now, these programs have "risen from the ashes", so to speak.

I believe what you said is true. This is wrong of The Villages to do this to their residents.We all signed up in good faith. Bait and switch as you said. Such greed.

Welcome, fellow outcasts. Ocala and Leesburg aren't that far away.

Folks, this is a business and the goal is $ . It is difficult to believe that VHS will remain viable after this move. Not many of us former military, Feds, and educators will give up our insurance plans--and there are a LOT of us!

Do we know whether this is official or still in rumor stage?

I haven't seen the warm, fuzzy "Marcus Welby" propaganda touted lately.

If this decision has been made, it would be considerate of them to let us know sooner rather than later.

Hard to say without some actual numbers.

It's only greed when it's not going in your pocket right?

I should have added that history has shown that TV does not make poor business decisions. If this change happens, you can be sure they have thoroughly researched the pros/cons and the money is there.

Neither side--you nor VHS--signed a contract. They can do what they want even if people think it stinks. I don't see it as bait and switch at all.

If I decided to leave VHS for whatever reason, would that be bait and switch? Did I promise to remain there for life?

It's a free marketplace. All they have to lose (apparently) is some goodwill. We'll get over it; they'll make bucks. :spoken:

Correct. I was speculating and am likely wrong.:bowdown:

I don't know what you mean but it seems a bit harsh. I would never try to increase my income at the cost of someone's health. If you knew my history as an RN and the pains taken to insure excellent patient care, you would not be so flippant.

I agree 100%. Unfortunately for us patients, health care is a very fluid situation these days, forcing both providers and patients to make difficult choices. VHS's decision is no different than a solo practitioner in Podunk deciding to no longer accept Aetna. These insurance decisions face medical practices every year, and believe me they are not easy, since sometimes it means dropping an insurance that covers a long time patient. Hardly bait and switch--you have to go to an auto insurance company for that:1rotfl::1rotfl::1rotfl:

No, we signed up like any other consumer of goods and services: We can take it or leave it and can enroll in Medicare with supplement with other dr. groups in the area.

People in some other countries would love to be able to have that option with their government healthcare.

If you want cite "greed", how about calling out the "greed" for power of all those in Washington who cook up the self-serving incentives for Medicare Advantage plans to double and boom, at the expense of Medicare.

You people are dumber than dirt if you think UHC Villages Healthcare didn't pull the old bait and switch on us. Go ahead and defend the developer's chosen UHC. I joined last October with assurances from three different UHC people that I would be grandfathered in. I never would have joined without those assurances. In less than three months, I get the letter; switch or leave. Quit making fools of yourselves with your pathetic defense of these charlatans. Is it legal what they are doing? Yes. Is it ethical? H3ll No!

Right, AND it's also a matter of "you get what you pay for".

People have warned on here many times that the AARP -UHC Plan, and now The Villages UHC plan like it, are HMOs that do not include the outside specialists they needed at other teaching-research hospitals in a major health crisis with aggressive cancer or other rare/complex diagnosis.

Many comments are on this board saying the AARP- and TV-UHC plan was fine UNTIL they got into a crisis that they needed Drs for in Tampa or elsewhere, but the plan didn't include that, and some were lucky to be in the enrollment window to change to regular Medicare with supplement when they needed to. There was a thread just a couple of weeks ago with a person saying this happened to him, and he was thinking of changing back and people said "don't do it" because that lesson should already have been learned--the hard way.

But wait --- "if you like your health care and your doctor, you can keep them" --- right?

Unfortunately, The Villages Health didn't say that!!

I'll ask this question again. Can anyone confirm this rumor?

I have already been kicked out of the Villages Health,because I'm not on Medicare yet.I have insurance through my former Employer.I will not give that up for Medicare United Health Advantage.It's all about money!!!!!!

If I were you, I would call and ask. Then it's no longer a mystery.


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I asked a couple of weeks ago at the Colony facility. They would not confirm or deny that there would be a change coming up in the next enrollment period. Then they invited me to speak to the UHC rep, who did the same while trying to sell me on the plan. I requested and got a call from the manager of the Colony facility who also would/could not provide a definite answer to my question.

IMO, the VHS system was and is unsustainable if they have to rely on reimbursement rates for specific procedures and keep panel sizes down. That is why they are pushing patients to the advantage plan where they have a known sum of money to manage their patients and keep each physician's patient volume optimal.

My wife and I have been tossing the question around whether to stay with VHS using the UHC plan or continue with straight Medicare and TFL. I spoke to a rep from Tricare and was assured switching to the UHC plan had no effect on my TFL except that I lose the pharmacy coverage. And was assured that in the event I dropped the UHC plan at the next enrollment period and reverted to Medicare, all I had to do was contact TFL and let them know so my pharmacy coverage would resume.

We really enjoy the access to care at VHS. If I call, I get in soon. When I have an appointment, I am called in on time or shortly thereafter. Very different from my experience taking my mom to her appointments. It's not unusual to wait 40, 50 minutes or more past the appointment time to be seen. That's because provider reimbursement has been the main area hacked in efforts to slow the growth of health care spending. As a result, overbooking is the norm. Thus the long waits.

The info below is from The Villages Health web site:

Accepted Insurance
If you are eligible for Medicare, we want you to know that the only Medicare Advantage plans The Villages Health participates in are those offered by UnitedHealthcare®.

UnitedHealthcare® The Villages® MedicareComplete® (HMO) Plan 1
UnitedHealthcare® The Villages® MedicareComplete® (HMO) Plan 2
AARP® Medicare Complete Choice® (Regional PPO)
AARP® Medicare Complete Choice® (HMO)
United Healthcare® Medicare Advantage Dual Complete


We continue to Participate with the following Commercial Insurances:

Avmed
Blue Cross & Blue Shield
Cigna
Multiplan
Private Healthcare System/PHCS
Tricare Standard
United Healthcare

A significant issue with the VHS, IMO, is their failure to provide a full panel of specialists, and especially sub-specialists from places like Gainesville, Tampa and Orlando. When USF backed out of the arrangement, it really changed the capabilities of VHS, and altered the promise of VHS to meet the needs of TV residents.

Recall that Moffitt did the same thing, and Moffitt is just another arm of USF after all.


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Totally agree! This is the primary issue for us.

It looks like the marketing push for MA has started. Today's article talks about how great the quality of care is at The Villages Health because they have teamed up with UHC Medicare Advantage. Did I miss the part about how it is big money-maker for TVH? I am waiting for the other shoe to drop for Medicare Original patients. Get ready to be "porked"!

They lied to me three times. I had to wait for the letter.

I also was told once I would be kept and later that I would not. was told by a provider there that decisions change all the time, so I doubt there is a conclusive answer.