XLHealth optimistic about special needs plans

XLHealth, a Baltimore-based provider of health plan solutions for Medicare beneficiaries with special needs, announced the enrollment of its 100,000th member, and it sees room for more growth despite expected Medicare Advantage cuts.

“There is going to be increasing downward price cut pressure on all plans,” says Paul Serini, executive vice president, XLHealth. “As a starting point we’ll have that same pressure. That said, most of healthcare reform is aligned with special need plans like ours.”

He says in the next two to four years, he sees tremendous opportunities for special needs plans.

“When the dust settles from healthcare reform, any MAPD (Medicare Advantage Prescription Drug) company serving a population that’s complex enough can do a better job than traditional services,” he says. “We know we can deliver better value to our members and the Medicare system for the chronically ill.”

XLHealth focuses on a largely rural, medically underserved market and targets older members. Care Improvement Plus' chronic condition special needs plan combines medical coverage - hospital and doctors' visits - with tailored Medicare Part D prescription drug coverage and care management support for Medicare beneficiaries with diabetes and heart failure.

Care Improvement Plus launched in 2006 and now serves seniors in Arkansas, Georgia, Missouri, South Carolina, Texas and 11 Maryland counties.  XLHealth estimates that approximately 7 million Medicare beneficiaries across all six states are eligible to enroll in a Care Improvement Plus plan and benefit from its model of care.

Serini says the company plans to expand in 2012. It has a target list of seven more states and 170 counties.