Blues add doctors to Medicare HMO 12 physician groups join Medi-CareFirst

Health care

March 01, 1996|By M. William Salganik | M. William Salganik,SUN STAFF

Blue Cross and Blue Shield of Maryland yesterday announced contracts with a dozen physician groups for Medi-CareFirst, its Medicare health maintenance organization.

The contracts bring the number of participating physicians from fewer than 100 to about 900, and give Blue Cross access to thousands of patients as it looks to expand its Medicare managed-care business.

In January, Blue Cross won approval to offer Medi-CareFirst with no monthly premium. The plan includes eye exams, dental care and prescriptions up to $1,000 a year -- items not included in many "Medigap" Medicare supplemental policies, for which subscribers pay about $100 a month.

The plan also covers Medicare deductibles and requires smaller co-payments than regular Medicare coverage. There is no premium for the HMO plan, but subscribers still pay Medicare Part B premiums.

Blue Cross is able to offer the plan with no premiums because the federal government pays the insurer a fixed fee, based on average Medicare claims in the region -- regardless of how much care the patients receive. Also offering zero-premium Medicare HMOs in Maryland are Chesapeake Health Plan, Humana, NYLCare and Optimum Choice.

Participants are limited to plan doctors, and with such a small number of physicians, Blue Cross initially attracted fewer than 1,000 subscribers out of Maryland's Medicare-eligible population of half a million.

"Normally, seniors develop a close relationship with their providers, so the more providers we recruit, the better it is for them," said Sandy Beard, Blue Cross director of marketing.

Dr. Scott Rifkin, chairman of Doctors Health System, said this is the first capitated, managed-care Medicaid contract for his medical group, and that it would allow the group to focus on preventive medicine.

He said he thinks that many of his patients would choose the plan, because they could keep their current primary physicians and, in most cases, their specialists as well.

The 12 groups signing with Blue Cross are: Anchor Health Network, Clinical Associates, Delmarva Health Plan, Doctors Health System, HelixCare, Maryland Health Network, Maryland Personal Physicians, New American Health, Patuxent Medical Group, Physicians Planning Group, Potomac Physicians and SinaiCare.

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