Baltimore's XLHealth to operate in 6 states



XLHealth, a Baltimore company that this year launched a local Medicare HMO aimed at the chronically ill, plans to expand next year to five more states.

In all, the company hopes to increase enrollment from the current 400 to 500 members in the Baltimore area to 3,000 to 4,000 by early next year. With the five new states, total enrollment could reach 25,000 to 30,000 by the end of 2007, Paul A. Serini, executive vice president of XLHealth, said yesterday.

The company said it had received preliminary approval from the federal Centers for Medicare and Medicaid Services to operate its Care Improvement Plus plan next year in Arkansas, Georgia, Missouri, South Carolina and Texas. It also plans to add Calvert, Charles and St. Mary's counties to its Maryland plan.

Care Improvement Plus enrolls members with diabetes, congestive heart failure and end-stage renal disease. Next year, it's adding a fourth condition, chronic obstructive pulmonary disease. Serini said that condition is common in patients it's already enrolling.

This is the first year Medicare has offered "special needs" health plans. Most, such as those offered by Baltimore-based Elder Health, are for members eligible for both Medicare and Medicaid, meaning they are low-income and either elderly or have disabilities. A dozen are, like Care Improvement Plus, aimed at those with chronic diseases.

Members pay a monthly premium, but the health plans collect most of their revenue from Medicare, which offers much higher payments for illnesses that are difficult and expensive to treat.

For example, for a healthy woman age 65 to 69 in Baltimore County this year, Medicare will pay a health maintenance organization $271 a month. But it will pay more than five times that - $1,392 a month - if the woman has diabetes with complications and heart disease.

If the health plan can manage the chronic conditions well - for example, giving patients regular checkups and monitoring medication, to avoid expensive hospitalizations - it makes a profit. XLHealth, for example, gives some heart patients electronic scales that record weight. Weight gain is a sign of fluid retention, which can indicate heart problems; medication can be adjusted before the problems become more serious.

Nationally, there are about a half-million members in special-needs plans, most for Medicare-Medicaid "dual eligibles."

Few HMOs entered the market for patients with chronic diseases this year because those cases are "harder and more complicated," said Marsha Gold, a senior fellow with Mathematica Policy Research Inc. in Washington. However, Gold said, the number is likely to expand next year as the health plans have more time to develop their programs. Gold has published several studies on Medicare HMOs.

Serini said this has been "a test year" for Care Improvement Plus, a chance for XLHealth to find out "what works and what doesn't work." Enough has worked, he said, that the company expects its health plans for the chronically ill to be profitable in 2007.

Serini said the company will realize some savings by centralizing operations such as enrollment and technical support. However, he said, nurses, medical directors and salespeople will operate in each state.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.