Want to Know Where Health Plans in New York State Are Heading?   

INSIDE HEALTH PLANS with John Burke

Welcome to the second installment of my Frontline column. I hope your summer is going well and you are enjoying time with friends and family.

I’m often asked: how do we increase the number of people we’re helping through our Health Plans, enabling us to extend our mission (and grow our market share) in today’s very competitive environment?

The answer requires no crystal ball. The future lies, in great part, with our VNS Health Total plan—also known as a “MAP” plan (which stands for Medicaid Advantage Plus). Total brings together Medicaid, Managed Long Term Care (MLTC), and Medicare benefits in a single health plan.

Of the five managed care products VNS Health offers to New Yorkers, VNS Health Total is our only plan that’s actually two plans in one—it combines a Medicare Advantage plan with the benefits of a Medicaid MLTC plan designed to support individuals with long-term care needs.

MAP plans are for people who are “dual eligible” (they’re eligible for both Medicare and Medicaid coverage). These individuals tend to have complex health care needs, yet the care they receive is often fragmented. With a MAP plan, these individuals can manage all of their health care needs in one convenient place, which is simpler for the plan member and also ensures alignment across the member’s health care providers. In addition, with VNS Health Total, each member is assigned a skilled care manager who emphasizes preventive care, coordinates doctor appointments, and addresses potential social determinants of health such as housing, food supply and transportation.

In short, our VNS Health Total plan is exactly what dual-eligible New Yorkers need to live their best lives in their homes and communities—which is what our mission is all about.

Currently, nearly one million people in New York State are dual-eligible, but so far only a small fraction are enrolled in MAP plans. Our state partners want to see that percentage grow significantly; evidence shows that MAP plans provide better health outcomes for dual-eligibles with long-term care needs, and they do it more cost-effectively.

At VNS Health, we want to help our state partners achieve this by encouraging more dual-eligibles to enroll in our own Total plan—which will let us extend these better health outcomes to more New Yorkers while at the same time helping to grow our Health Plans business.

In fact, one of VNS Health’s Top Company Objectives is for our Total plan to be the leading MAP plan in New York State.

The good news is, we’re well on our way to achieving this goal. Our VNS Health Total plan is receiving high marks from current members for how it seamlessly combines Medicare and Medicaid benefits and for how well the plan manages the care of its members—which is no surprise, since VNS Health has very impactful care management aligned with deep consumer experience and expertise.

And here’s more favorable news: We also have one of the largest stand-alone Medicaid MLTC plans in New York State. That’s very significant, because the state is strongly encouraging MLTC members who are Medicare-eligible to switch over to MAP plans like VNS Health Total. Many of our own MLTC members have already moved to Total for all the reasons I’ve noted above. As our MLTC plan expands across the upstate region (it’s now available in over 35 counties and growing), we’re also increasing the number of counties where we offer VNS Health Total—Total is now available in the greater Albany area, and we plan to offer it in Buffalo and Rochester this fall. Service area expansions are planned for 2026 and 2027, as well.

I firmly believe growth of our MAP plan remains key to the future success of VNS Health; our expertise and commitment to complex and underserved populations is integral to our success and will deliver the most value to the neediest New Yorkers. I am excited to be deeply engaged with you in this important work.

I encourage you to engage with your management team, and I look forward to hearing your ideas and input as we continue to build the leading health plan in integrated care.

Until my next column…

To read the 2nd installment of INSIDE PROVIDER SERVICES with David Rosales, please click here.