Texas system shutters Medicare Advantage plan

https://www.beckerspayer.com/payer/texas-system-shutters-medicare-advantage-plan.html

Southwestern Health Resources will not offer Medicare Advantage plans in 2025, D Magazine reported Sept. 17. 

In emails obtained by D Magazine, the company said it decided to sunset its Medicare Advantage plan because of increasing competition and utilization, and regulatory requirements. 

“Medicare Advantage plans continue to face significant headwinds nationally related to challenging regulatory changes and increasing benefit utilization,” a spokesperson for Southwestern Health Resources told Becker’s. “We remain committed to providing high-quality services to our partners and members through this enrollment period. There will be no change for our members in 2024.”

Farmers Branch, Texas-based Southwestern Health Resources operates Care N’ Care, an MA insurer. The company has around 26,000 Medicare Advantage members, according to CMS enrollment data. 

Southwestern Health Resources is a joint venture between UT Southwestern Medical Center and Texas Health Resources. 

In regulatory documents filed Sept. 5, Southwestern Health Resources said it would lay off 129 employees. D Magazine reported 125 health plan employees were notified their jobs would be eliminated. 

“After careful consideration, we adjusted our organizational structure and aligned the staffing model to meet current business needs as the health care landscape continues to evolve. We are working to maximize value, quality, and service for our customers,” a Southwestern Health Resources spokesperson told Becker’s. 

Most of these jobs will end in January, D Magazine reported, with some roles staying on to manage the wind-down of the plan.

“In an effort to give impacted employees the best opportunity to successfully transition to another role, we have provided more than the required 60 day notice, as well as support and resources. In addition, we are working to place them in open roles within the organization,” the spokesperson said. 

Several insurers have cut back on their Medicare Advantage offerings, facing increasing medical utilization and lower reimbursements from CMS. 

Humana, CVS Health and Centene have all said they will exit some markets in 2025. 

In June, Blue Cross and Blue Shield of Kansas City said it would exit the MA market at the end of 2024, also citing increasing regulatory requirements and financial headwinds. 

Other health systems have shut down their affiliated Medicare Advantage plans in recent years. In 2023, Fredericksburg, Va.-based Mary Washington Healthcare ended its MA plan. 

In 2022, Inter Valley Health Plan, affiliated with Pomona Valley Hospital Medical Center, ended its Medicare Advantage operations. 

Read more here. 

 

Filed under: General Problems