Harvard Vanguard opts for Tufts

One of the state's largest physicians groups, Harvard Vanguard Medical Associates, will only accept Tufts Health Plan insurance for its Medicare Advantage patients starting next year.

Harvard Vanguard was once part of Harvard Pilgrim Health Care and currently treats only Medicare Advantage patients insured by its former parent.

The change will provide a major boost to Tufts, which has lost membership over the past several years and is expected to disclose another decline in membership in its first quarter earnings report later this month. It will have an opportunity to recruit many of Harvard Pilgrim's 33,000 Medicare Advantage patients.

''We're thrilled to have Harvard Vanguard and their physicians joining our network," said James Roosevelt Jr., chief executive of Tufts Health Plan. ''We bring a strong commitment to coverage for seniors and a very high reputation for medical management and customer service."

Bruce Bullen, Harvard Pilgrim's chief operating officer, said the company hopes to retain members in its Medicare Advantage plan, called First Seniority.

''They are familiar with the quality of the Harvard Pilgrim product, but they need to make a decision for themselves as to what's important for them. We'll try to offer them as attractive a product as possible," he said.

Bullen said Harvard Pilgrim would ''possibly" make changes to First Seniority to make it more attractive.

Medicare Advantage plans are HMOs that provide Medicare coverage to seniors. Patients with such coverage can only see physicians who are part of the health plan's network. The coverage is considered an alternative to traditional ''fee for service" Medicare insurance, which allows patients to choose any doctor.

The Bush administration has promoted Medicare Advantage plans and other private-sector mechanisms to deliver Medicare benefits to older patients. That effort and the growing population over age 65 have made the Medicare market an attractive segment for health insurers.

The switch from Harvard Pilgrim to Tufts, effective Jan. 1, 2007, means some patients may need to change their insurance coverage if they want to continue to be treated by doctors at Harvard Vanguard, which has locations throughout the Boston area, or at another doctors group, Dedham Medical Associates, which also is converting from Harvard Pilgrim to Tufts. To avoid changing doctors, patients covered by Harvard Pilgrim's First Seniority Medicare Advantage plan will need to sign up next year for Tufts' Medicare Preferred plan.

Patients who wish to stay with Harvard Pilgrim must select doctors outside the Harvard Vanguard and Dedham Medical Associates networks.

Tufts, Harvard Pilgrim, and Harvard Vanguard said they would all work to minimize paperwork for seniors who are affected.

For those who stay with their current physicians, the switch could mean little more than getting a different insurance card, said Roosevelt. ''Our goal is to make this as seamless as possible," he said. ''They'll see a different logo on their insurance card and other than that there'll be very little change."

Tufts Health Plan has long been recognized as a leader in providing coverage for seniors. It has 55,000 members in its Medicare Advantage plans, more than Harvard Pilgrim or Blue Cross and Blue Shield of Massachusetts. But overall, Tufts only had about 620,000 members at the end of 2005, while Harvard Pilgrim recently reported 925,000 and Blue Cross reported membership at 2.8 million.

Harvard Vanguard has about 400 physicians. It is part of HealthOne Care System of Newton, a network of several affiliated doctors groups. HealthOne had several of its groups working with Harvard Pilgrim Medicare Advantage coverage, and several others working with Tufts Medicare Advantage coverage. It began seeking proposals last year.

The change to Tufts coverage for Medicare Advantage patients was not driven by dollars, said Peter Dreyfus, a spokesman for HealthOne. Reimbursement rates -- the amount insurance companies pay doctors for services -- are comparable, he said. Nor is the convenience of consolidating its physician groups under one payment plan a deciding factor, he said.

Rick Lopez, acting chief medical officer of HealthOne, said Tufts's programs aimed at providing better healthcare for senior citizens were a good match with similar efforts at HealthOne.

''Some of the clinical programs that Tufts offers will augment our programs," said Lopez. ''Those include screening for depression and malnutrition and screening for high risk of falls. They have a very focused and strong expertise around geriatric care."

Jeffrey Krasner can be reached at krasner@globe.com.