CEO says system has been losing tens of millions of dollars and can't sustain further losses without risking borrowing ability
Scripps Health confirmed Tuesday that its clinic and coastal medical groups — which have been the provider’s most popular options for many patients — will stop participating in Medicare Advantage plans starting Jan. 1, 2024.publicly in early August, has been estimated to affect about 32,000 San Diego County seniors enrolled in a range of plans from organizations such as SCAN, Anthem, Alignment, MediBlue, Blue Shield, Health Net and United Healthcare.
Overall, he said, the care he has received from Scripps was of high enough quality that he wants to stay. By full risk the executive referred to a common financial arrangement between health insurance companies and large medical providers who receive blanket payments for each person they care for whether that care is delivered in a hospital, doctor’s office or skilled nursing facility. The idea is that operating efficiently and acting on illness early provides an opportunity for providers to spend less than they make..
Many might wonder, then, why Scripps coudn’t simply spend some of its savings and remain in the Medicare Advantage game. But Van Gorder said that the cash must be on the books in order for his organization to borrow the additional billions it needs to repair and replace Scripps Mercy medical campuses in Hillcrest and Chula Vista, and to make other seismic improvements mandated by state law.
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