Steward Health Care System has canceled its contract with Cambridge-based health insurer Senior Whole Health, effective Jan. 1, meaning it will no longer assign its staff doctors to treat about 900 elderly, low-income patients who are plan members.
Under a state law passed in 2000, low-income seniors who qualify for both Medicaid and Medicare — the government health insurance for poor and older people — can be insured through senior care option plans, which allow them to carry one insurance card rather than two.
Senior Whole Health, formed in 2004, is the largest of several organizations administering senior care option plans in Massachusetts. It provides nurse care managers, geriatric support services, and community resource coordinators who advise patients about benefits and interpret for those who do not speak English. It began working with Steward physicians when they were employed by Caritas Medical Group, which Steward acquired in 2010.
In a letter to Senior Whole Health chief financial officer Michael Wyman, Mark Rich, Steward’s executive vice president for corporate strategy and management, gave the required 90-day notice but offered no explanation for terminating the contract.
Pamela Gossman, president of for-profit Senior Whole Life, said she has tried without success to speak with senior managers at Steward to set up a meeting.
“It’s disruptive to care,” Gossman said, noting that many of those insured under the plan live in nursing homes. “They’re old, they’re frail, and most of them don’t speak English . . . These are patients who have significant numbers of chronic diseases. Our members have an average of five serious conditions. They take an average of eight prescription medicines. Their average age is 78.”
Gossman said patients will now have to choose between staying with Senior Whole Health and changing doctors, or sticking with their Steward doctors and changing insurance coverage. She said members seeing Steward physicians represent about 10 percent of Senior Whole Health’s business. The company, which also operates in New York state, won’t be financially hurt by the Steward move, Gossman said.
Steward spokesman Chris Murphy said the hospital and physician group is not backing away from the market for so-called “dual eligibles.”
“Steward does contract with a number of other insurers that provide the same coverage for dual eligibles at no cost to them,” Murphy said. “We are in the process of contacting impacted patients to ensure their access to their physician is not disrupted.”
He declined to say why Steward chose to end its contract with Senior Whole Health.Robert Weisman can be reached at firstname.lastname@example.org.