State Comptroller Kevin Lembo is preparing to issue a request for proposal that he believes will save Connecticut “tens of millions” of dollars in retiree health costs.
Lembo said after researching the issue he thinks the state could save money by implementing Medicare Advantage plans.
There are approximately 49,000 Medicare-eligible retirees and dependents covered under the Connecticut state health plan. Under the current system, when retirees become eligible for Medicare they are required to enroll in a Medicare plan. When those Medicare retirees utilize health care, the federal Medicare program pays approximately 80 percent of costs and the state is responsible for approximately 20 percent of those costs.
The state currently can only estimate at the beginning of each year what health care costs will be. By switching to a Medicare Advantage plan, an insurance carrier would contract with the state and, in the process, guarantee a fixed and predictable annual cost to deliver retiree health benefits, according to Lembo.
“The mission continues: do better work for less cost,” Lembo said. “Where health care is concerned, cost and quality are not at odds. A switch to a Medicare Advantage plan will not only save state costs, but actually improve the quality and efficiency of care for state retirees.”
However, Lembo said he would let the data drive the decision.
“The data, the research and the actuaries have demonstrated the benefits of using a Medicare Advantage plan: drops in emergency room use, drops in inpatient days, drops in readmission rates – all while increasing medication adherence, preventive screening rates and all of the usual benefits of actively managing care for a population,” Lembo said.
He said aside from successful implementation of these types of public employee health plans in other states Medicare Advantage plans typically include dedicated claims and customer service teams for state group plans that are specifically trained to support a senior membership, and these plans are designed to identify and connect retirees with the most appropriate clinical programs through predictive modeling and health risk assessments.
Medicare Advantage will offer members a robust national network that includes all physicians that accept Medicare, which is most, according to Lembo.
The RFP to implement the program will be issued on Friday, but full implementation is still subject to approval by labor and management.