It is with deep sadness and disappointment that we share that Vista360health will not be offering new plans in the upcoming market for 2019. Although we believe we have done amazing things with our health plan and have sought to serve our Members and Providers with integrity, aspects of the Affordable Care Act have made it impossible for us to continue.
To say that we have appreciated your support and trust in us to provide you with quality healthcare coverage, would be an understatement. Please be patient with us as formal letters are being sent to Members and Employers providing the required 180-day notice of termination. We highly recommend that Members select a new plan during the ongoing Open Enrollment period which ends December 15, 2018, to ensure a choice of coverage effective January 1, 2019.
How did this happen? In a nutshell, an aspect of the Affordable Care Act transfers money from insurance plans with healthier members to plans with sicker members. The aim of the law was to keep plans with high-risk patients solvent but, in so doing, it has created a big unintended problem – many smaller plans and Co-ops are penalized. The government calls it the Risk Adjustment Transfer (RAT). See here the 2017 summary report. https://downloads.cms.gov/cciio/Summary-Report-Risk-Adjustment-2017.pdf
How much are we talking about? The government has assessed our 2017 RAT payment at 51% of our total premiums. Consider for a moment that 80% of our revenues go to reimburse doctors, pharmacies and hospitals for the great care provided to our Members. So, if you add that together…. well you do the math, it doesn’t add up – 51% + 80% = 131%. Hard to keep operating with losses like that. If Vista did not have the 2017 RAT liability, we would not be in this position.
Why are you leaving the Market? With a $4.3 million liability assessed for the 2017 RAT, plus the potential for a similar 2018 RAT assessment, it is not financially feasible to offer any plans for 2019.
We at Vista360health are very disheartened by the turn of events for our company, largely because our goal to help members who get lost in the healthcare maze, will be no more. Once again, we appreciate all the trust you have shown us. Thank you for your support and partnership.
Your Vista360health Team