Virginia Premier Merges with Optima Health to Serve Over 740,000 Medicaid Members in Virginia

Virginia’s Medicaid landscape is undergoing a significant transformation as Virginia Premier, serving over 300,000 residents, merges with Optima Health. This consolidation, effective July 1, 2023, brings Sentara Health’s two Medicaid subsidiaries under one umbrella, creating a plan catering to over 740,000 Virginians.

This move promises several benefits:

  • Enhanced Customer Experience: Sentara Health Plans President Colin Drozdowski emphasizes a “superior customer experience” for Medicaid recipients. Optima Health, presumably with its existing infrastructure, aims to deliver a streamlined and efficient service for the combined membership.
  • Cost Savings and Efficiency: The merger is expected to generate cost savings for the state by optimizing administrative processes and potentially leveraging economies of scale. Healthcare providers might also benefit from a reduction in administrative burdens associated with dealing with multiple Medicaid plans.
  • Community Investment and Seamless Care: Sentara anticipates reinvesting the efficiencies gained into Virginia communities. This could translate into improved outreach programs, community health initiatives, or potentially even expanded healthcare services. Additionally, a unified plan could lead to a more seamless care experience for members, potentially simplifying referrals and coordination between different healthcare providers within the  Sentara network.

Impact on Virginia Premier Members:

For existing Virginia Premier members enrolled before July 1, 2023, the transition appears smooth. They will retain their current health coverage and benefits, becoming Optima Health members automatically. The Virginia Premier D-SNP program, catering to a specific population segment, will continue under the Virginia Premier name, ensuring continuity of care for those enrollees.

However, during future open enrollment periods, Virginia Premier will no longer be a separate option. Members seeking to retain coverage will need to choose Optima Health.

Sentara Health Plans and Beyond:

This consolidation coincides with Sentara Health’s broader rebranding efforts. The company is adopting “Sentara Health Plans” as its official health insurance arm, reflecting its integrated healthcare delivery network (IDN) structure. This rebranding, coupled with the merger, signifies Sentara’s commitment to a more unified and streamlined healthcare ecosystem in Virginia.

The rollout of the Sentara Health Plans brand is expected to begin this fall, with new ID cards reaching Virginia plan members by January 1, 2024.

Looking Ahead:

The Virginia Premier-Optima Health merger simplifies Medicaid administration in the state, potentially reducing costs and improving the overall experience for hundreds of thousands of residents. While some transitional adjustments might be necessary, Sentara’s commitment to reinvestment and streamlined care bodes well for the future of Virginia’s Medicaid landscape. It’s important to stay informed about any updates or changes communicated by Sentara Health Plans in the coming months.

 

 


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