Sanford Health Plan is expanding its Medicare Advantage offerings to more rural communities.
In December, Sanford Health Plan, part of Sioux Falls, S.D.-based Sanford Health, partnered with Lincoln, Neb.-based Bryan Health. The partnership will begin offering MA plans to older adults in Lincoln and the surrounding area in 2026.
Tommy Ibrahim, MD, CEO of Sanford Health Plan, told Becker's the system would like to create additional partnerships in the future.
Becker's caught up with Dr. Ibrahim to learn more about Sanford Health Plan's partnership with Bryan Health and the outlook for Medicare Advantage in rural communities.
Editor's note: This conversation has been lightly edited for length and clarity.
Question: Why was Bryan Health the right partner, and why was now the right time for this type of joint venture?
Tommy Ibrahim, MD: This is a strategy we're actively exploring nationally. We've been in discussions with Bryan for over a year — particularly about the strategy — and garnered their interest early on. We find them to be an incredibly aligned partner in many respects. They're advanced in the delivery of rural healthcare, which is a strength and a mission of Sanford Health. There's strong cultural alignment. There's geographic synergy.
Most importantly, they are really forward thinking about value-based care. They've already assembled a very strong provider network, and really understand the mechanics of being successful in value-based care. They have an accountable care organization, for example, that manages 30,00 lives, and they demonstrated great success in improving quality, safety and focusing on the experience and reducing the total cost of care. All of those criteria made them an ideal partner for us. As we look to other potential partners, we're using a similar phenotypical profile to identify and engage in those conversations.
Q: Medicare Advantage enrollment is lower in rural areas than in urban and suburban areas. What does it take to make Medicare Advantage successful in a rural market?
TI: The fact that penetration has lagged behind is due to a couple different issues. Network adequacy is always a challenge, making sure you have the appropriate provider networks so members can actually get the care they need, see the specialists they need. It becomes harder to recruit to rural markets and make sure those providers are in place. We've addressed that through this partnership with Bryan, because they certainly have a bench and strength from a network adequacy perspective.
Often, patients will listen to their physicians. Physicians aren't referring their patients to a Medicare Advantage product, and that certainly does slow the penetration. We are focused on working closely with the provider base to educate on the benefits of a Medicare Advantage plan, the bundled, comprehensive [services] we bring — not only with medical and surgical services, but with vision, dental and some of the other supplemental benefits you don't get with traditional Medicare.
We really focus on quality. We've been able to demonstrate significant improvement in the patient experience, significant retention of members within our plan. We have a 4.5-star quality plan as well. The benefits of having utilization management, patient navigation and comprehensive engagement that we've put together have made it such that the benefits truly do stand out and create a differentiated product in the market. As we continue to focus on that differentiation, we think rural markets will see that advantage and take a closer look at MA, and over time those penetration rates will continue to improve.
Q: Many providers, rural providers especially, are concerned about reimbursement and other challenges in MA. Is that something you're focused on at Sanford, and what does it take to successfully partner with providers in rural markets?
TI: We think about it all the time, and that's exactly why our products are opting for a different approach. We're not for profit. We're focused on taking care of the community and investing in our plan. We're not out to benefit shareholders. As a result of that, we do things very differently.
There's a lot of angst out there these days. There's always some sort of national headline on prior authorization, denial rates and some of the other tactics that some of the other larger, national players may implement. We really focus on making sure we take care of our members. As an example, our prior authorization rates are significantly less than national averages. We do an excellent job to turn those around within 24 hours, whereas you might have some other plans out there, really prolonging that decision process.
Q: Are you targeting more joint venture partnerships like the one you have with Bryan Health in the future?
TI: We're always evaluating potential growth and partnership opportunities. We'd like to continue to focus on rural markets and work with likeminded providers that fit the phenotypical picture I outlined earlier. From my perspective, it would be great to have not-too-distant relationships across the Midwest, geographically dispersed to where there's not a lot of overlap, and target somewhere between eight to 10 partnerships along these lines. [We can] use this as a platform to build those relationships and continue to expand our mission to rural communities.