Universal American Corp., a specialty health and life insurance holding company, provides health insurance and managed care products and services to people covered by Medicare and/or Medicaid. Segments The company manages and reports its business in Medicare Advantage, Management Services Organization (MSO), and Medicaid segments. The Medicare Advantage segment includes Medicare Advantage businesses. The MSO segment supports its physician partnerships in the development of value-based healthcare models, such as ACOs, with various capabilities and resources including technology, analytics, clinical care coordination, regulatory compliance and program administration. The Medicaid segment reflects the operations of the company’s Medicaid business in upstate New York, which consists of approximately 39,000 members in the Total Care Medicaid plan centered in the Syracuse, New York area. Businesses The company focuses on three main businesses. Medicare Advantage: The company serves the Medicare population by providing Medicare Advantage products to approximately 114,000 members, as of December 31, 2015. Its focus is to grow its Medicare Advantage business in Texas (especially Houston/Beaumont), upstate New York (especially the Syracuse area) and Maine, regions in which it has market positions. Medicare Accountable Care Organizations: The company addresses the high cost and lack of coordination of health care for the majority of the Medicare fee-for-service population and has joined with provider groups to operate accountable care organizations (ACOs) that participate in the Medicare shared saving program (MSSP). The company operates 21 MSSP ACOs and 1 Next Generation ACO, including approximately 3,200 participating providers with approximately 236,000 assigned Medicare fee-for-service beneficiaries. Medicaid: The company also owns and operates the Total Care Medicaid health plan, serving approximately 39,000 members in upstate New York. Strategy The key elements of the company’s strategy include aligning incentives through gain sharing arrangements so that providers are incented to assist members to achieve healthy outcomes; providing actionable data and analytics to providers and employ enabling technology to ensure that the right care is delivered at the right time in the right setting; and engaging the people it serves to help them make informed choices about their healthcare. Medicare Advantage The company offers Medicare Advantage plans in three states, which include Texas, New York and Maine. In upstate New York, the company is in the process of converting the historically fee-for-service market into a value-based system by introducing pay for performance to the primary care physicians in the region. Medicare Advantage—Texas: The company's major Medicare Advantage market is Texas, primarily the Houston/Beaumont region and North Texas. It markets its products using the TexanPlus brand. The company’s HMO plans are offered under contracts with the Centers for Medicare & Medicaid Services (CMS) and provides all basic Medicare covered benefits with reduced member cost-sharing, as well as additional supplemental benefits, including a defined prescription drug benefit. In connection with the HMOs, the company operates separate Medicare Advantage Management Service Organizations that manage that business and affiliated Independent Physician Associations. Medicare Advantage—Northeast: The company’s other major market is upstate New York, primarily the 10 counties that are part of the Syracuse market. It markets its Medicare Advantage products using the Todays Options brand. The products provided in its Northeast market include PPO, Network PFFS, and HMO plans. The company’s HMO and PPO plans are provided under the brand Today's Options HMO and Today's Options PPO, respectively. They are offered under contracts with CMS and provide all basic Medicare covered benefits with reduced member cost-sharing, as well as additional supplemental benefits, including a defined prescription drug benefit. This coordinated care product is built around contracted networks of providers who, in coop
universal american corp (UAM:New York)
44 South Broadway
White Plains, NY 10601
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