Offering VNS Health’s Managed Care Products and Services to Other Organizations

An Interview with Marshall Ellis, Chief Operating Officer of VNS Health’s Management Services Organization (MSO)

What is your role at VNS Health?

As the MSO’s Chief Operating Officer, I oversee the development of short- and long-term managed care goals related to our MSO operations. I also make sure we’re effectively performing the managed care services we’ve sold to our customers, which includes VNS Health’s own Health Plans. My job is to ensure that we’re operating in an efficient and streamlined manner, so we can surprise and delight our customers every day.

VNS Health’s Health Plans are a customer of the organization’s MSO? How does that work?

At the start of 2022, eight functional departments moved over from our Health Plans division to the MSO. These include delegated health plan functions such as utilization management, care management, pharmacy services, and appeals & grievances, as well as other support functions such as claims processing oversight, provider data management, and education & training. We are focused now on optimizing these services for our Health Plans and putting ourselves in a position to provide similar services to other insurers besides VNS Health.

Does that include working with health plans outside New York State?

Absolutely. We’re casting a wide net, reaching out to insurers across the U.S. who might potentially benefit from our health plan management expertise. In January, we began partnering with a national hospice provider and a Medicare insurer based in the southeastern U.S. to manage the insurer’s participation in a CMS demonstration project around hospice benefits. Our own health plans were already participants in the same demonstration, so this is a great example of taking one of our core competencies and partnering with national players to deliver an outstanding service to another insurer’s plan members. We’re now looking for opportunities to provide that same hospice benefit support in other parts of the U.S., as well.

What else is in the works?

VNS Health has over two decades of experience administering managed care plans, including what are currently the only 4.5 Star-rated Medicare plans in New York City and Long Island. Our MSO intends to leverage that expertise, as well as the core competencies of VNS Health as a whole, to not only provide health plan services but also develop useful support products. For example, drawing on what we’ve learned from running managed long-term care plans, we’ve developed an algorithm-driven tool called HELPS, that determines the appropriate level of personal care services for plan members. We’re marketing the tool in New York State now and hope to offer it to health plans around the country soon.