What Our Health Plans Are Focusing on in 2025

INSIDE HEALTH PLANS with John Burke

Welcome to my Frontline column, “Inside Health Plans.”

Sometimes you can just sense that things have shifted into a higher gear. That’s how I feel about our Health Plans—and all the team members involved with them.

Midway through the first quarter of 2025, we’re on a real roll. Our three Medicare plans—EasyCare, EasyCare Plus, and Total (our integrated Medicare-Medicaid plan)—had a hugely successful annual enrollment period last fall, bringing in over 10,000 new members!

What’s more, our Total plan earned the highest MAP plan quality rating in New York State! Meanwhile, our Medicaid MLTC plan continues to grow, adding nearly 1,000 members from Kalos Health this past December. This was our fourth MLTC plan acquisition of 2024.

So what’s ahead in 2025? Here are the areas we’re focusing on:

• Raising our Medicare quality scores—Our Total plan received a perfect 5 Stars from New York State for its Medicaid component, and the state also gave our Medicaid MLTC plan a nearly perfect 4 Stars—but the CMS ratings for our Medicare plans are lagging at 3.5 Stars. In 2025, we’re laser-focused on raising our Medicare quality ratings, with an emphasis on enhancing how we communicate with our members.  

• Strengthening our partnerships with physicians—More than half of the new Medicare members we enrolled last year were referred to us through Independent Practice Associations and other physician groups. We’ll continue to focus on building and nurturing these important relationships in 2025. 
• Increased enrollment—Collectively, our five health plans now have 57,500 plan members. If we meet our enrollment targets, which I believe is very doable, we’ll be pushing for 70,000 members by year’s end!
• Growing VNS Health Total (MAP)—Our MAP plan is now available in 11 New York counties, with two pending. We’re currently applying to offer our Total plan in 10 additional upstate counties. We could know the results of these filings as early as July—so stay tuned!
• Getting more MLTC plan members enrolled in our Total plan—We currently have about 27,000 members in our Medicaid MLTC plan, and many of them are also Medicare-eligible. Enrolling these MLTC members in our Total plan where appropriate is a top priority for 2025.
• Continuing to grow our SelectHealth plan—For three straight years, SelectHealth, our HIV Special Needs plan, has been growing its membership. While maintaining its steadfast commitment to serve those living with HIV, the plan has also been enrolling additional members from New York’s transgender and homeless population, following the state’s expansion of eligibility criteria to include these groups. In the coming year, through our continued partnerships with community-based outreach organizations such as The Floating Hospital, we look forward to serving thousands more New Yorkers who are living with HIV, experiencing homelessness, or both.

See what I mean about things shifting into a higher gear? And with our amazing Health Plans team, I’m confident it’s going to be full speed ahead in 2025!