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New Medicare Advantage Plan Helps Patients Navigate Care

Dec 19, 2021 09:05PM ● By Med Magazine

This fall, Sanford Health opened enrollment for Align powered by Sanford Health Plan. The plan combines Medicare Part A and Medicare Part B coverage with more tailored, comprehensive health benefits, and prescription drug coverage. 

MED spoke with Sanford Health Plan president John Snyder to learn more about what makes this offering stand out from other Medicare Advantage options on the market. 

MED: What are some of the advantages of Medicare Advantage plans?

JS: Medicare Advantage is much more all-encompassing because it covers both hospitalization and ambulatory care (Medicare Parts A & B). Generally, the co-pays are lower and the benefits are much more comprehensive. With a Medicare Advantage plan, Medicare recipients don't need a supplemental Medicare policy. And because providers are paid so much per person per month, the incentives are aligned to keep people well. So it is a much more population health based approach.

The downside is that it is typically a more narrow network. You can't just go anywhere you want to, or else you have to pay. 

MED: So how is Align powered by Sanford Health Plan different?

JS: Especially if a patient is already a Sanford patient, this really aligns everything. We are an integrated network. We can take that total picture and manage health and wellbeing in a better way. The fact that we are an integrated system means that we can streamline things like prior authorization, which can often show things down, because we are all together in one system. And because we are integrated, there are efficiencies that allow us to take those dollars and craft a better benefits package. 

MED: Tell us about the navigators that are part of this plan.

JS: The other unique thing is that we have navigators whose job it is to help patients find whatever they need to stay healthy and well. If a person needs help scheduling an appointment, arranging transportation, or even just explaining things, our navigators are here to help. They are tied into Sanford so they know the Sanford system. 

MED: Why do you feel like this approach is the wave of the future for healthcare?

JS: If you think about incentives in a fee-for-service world, providers get paid when people need their services. The cost of fee-for-service continues to escalate for everyone. Sanford tries to do things from a wellness perspective. When you align incentives, you are going to get different outcomes. 

MED: Can you give me an example?

JS: We have people who are trying to proactively manage things like chronic diseases. When you can intervene ahead of time in people with rising risk, you are more likely to keep them healthy. For instance, we partner with a company that has a great platform for managing diabetes. Patients can check their blood glucose and that information is communicated to the health plan. If we spot a problem, we can call them. 

When you are incentivized to keep people well, instead of just treating them when they are sick, you can do things like that. This will eventually bring down the cost of healthcare overall. 

Align by Sanford Health Plan is available to Medicare beneficiaries in select counties across South Dakota, North Dakota and western Minnesota.  Annual enrollment will open again next year.