Reaching Even More Vulnerable New Yorkers Across New York State

Here is the latest in our series, “Objectives in Action.” Each month, we feature a team from across the organization that’s working to make one of our 4 Top Company Objectives a reality. Today we feature our Health Plans team.

Top Company Objective: Lead New York State in integrated long-term care (VNS Health Total)

Team: Health Plans

The opportunity: VNS Health is looking to grow its integrated health plan, VNS Health Total, available to New Yorkers eligible for Medicare, Medicaid, and MLTC (long term services and supports). We are actively expanding our service area to include additional counties in Upstate New York. Our Total product became available in July 2023 in Albany, Rensselaer and Schenectady Counties; it will also be offered in the fall to residents in Erie (Buffalo) and Monroe (Rochester) Counties for 2025, pending DOH approval. The existing footprint of our MLTC plan now extends to over thirty-five counties throughout New York State, with the ultimate goal of giving most of our MLTC members the opportunity to enroll into Total in the coming years.

The big picture: Fully integrated plans like VNS Health Total represent the future when it comes to ensuring that dual eligible members receive the most comprehensive and coordinated care in New York State. Our government partners understand that these integrated plans are the most effective way to support the health of dual-eligible individuals, which is why they’re encouraging eligible New Yorkers to migrate from Medicaid MLTC plans—which require members to enroll separately in Medicare—to integrated plans. At the same time, MLTC plans have been a focus in the past few New York State budgets due to growth and spending. The reality is that most MLTC members are dually eligible and can enroll in fully integrated plans like VNS Health Total. Recently, the state mandated that organizations without affiliated Medicare D-SNP plans transfer their MLTC memberships to insurers like VNS Health that do administer such plans.

Top Company Objective in Action: To grow our MLTC plan in size and geographic reach, VNS Health has acquired approximately 2,000 members of three MLTC plans in upstate New York that recently closed due to the state’s MLTC budget mandate. Our provider network will now include providers who were previously serving members of these three health plans.

Here are the three plans we’ve acquired members from:

• Elderwood Health Plan (May 1) – Elderwood operates in six counties in the Buffalo/Rochester area. In acquiring this plan’s members, VNS Health is expanding its health plan operations into four New York State counties we weren’t operating in before.
• Prime Health Choice (May 1) – This plan is active in seven counties in the Albany/Hudson Valley area.
• Senior Network Health (SNH) (June 1) – This MLTC plan provides coverage to Medicaid recipients in two counties in the Utica area.

Why it matters: Besides increasing our MLTC market share (going forward, we expect to be the largest MLTC plan in western New York with over 30% of the market), these acquisitions also position us to grow our integrated plan, VNS Health Total, in the regions where these MLTC plans are located. This growth will happen in two stages—first by launching Total in these regions, and then by working to grow Total’s enrollment, in part by educating our current MLTC members about the value of a fully integrated plan like Total.

The launch stage is already underway: VNS Health Total began operating in three Albany-area counties last July and will begin operating in Buffalo’s Erie County and Rochester’s Monroe County this coming January, pending DOH approval.

Driving towards our 3-year goals: Increasing membership in our MLTC and Total health plans contributes to our goal of having 100,000 patients, members, and clients in our care by 2026.

What Health Plan team members are saying: “We’re excited to add these additional plan members and network providers,” says John Burke, Executive Vice President and Chief of Health Plans. “This will allow us to reach even more vulnerable New Yorkers.”