St. Vincent to dangle deal to employers
For decades, hospitals have tried to cut out the health insurance middleman by contracting directly with employers - with only limited success.
But
The hospital system and a partner company have started meeting with health insurance brokers to pitch a program to save employers money by keeping workers and their families healthier.
The program is operated by
MissionPoint has hired 40 people in
Now, MissionPoint is pitching the program to employers that fund their own health benefits with this message: If you direct your employees to get care at St. Vincent, it will slow the growth in what your company spends on health benefits. If that happens, your company will share some of the savings - in the form of a bonus payment - with St. Vincent.
Such contracts represent a big change from traditional ones, which gave doctors and hospitals incentives to perform as many procedures as possible to as many patients as they could attract, driving up spending year after year.
"We're focused on keeping their employees healthy, and that is helpful financially to the company as well," said Dr.
The move comes about a year after the end of a similar effort in which St. Vincent partnered with
That consortium signed up nine employers in its first year, but then the partner hospitals decided they would be better off working separately. They dissolved the consortium in early 2014.
But while the consortium died, the concept of hospital systems being rewarded for the financial savings they achieve by keeping patients healthier is gaining traction quickly.
For example, both St. Vincent and Community have signed "shared savings" contracts with the state's largest health insurer,
Around the state, 454,000 Anthem customers are now covered by these kinds of contracts.
"This is not a fad, if you will," said
St. Vincent and MissionPoint hope to partner with a health insurance plan to offer the program to smaller employers and to individuals on the Obamacare exchange, likely for coverage that starts in 2017, said Dr.
In
St. Vincent is no stranger to the world of insurance. In 2000, it joined with Franciscan and other Catholic hospital systems to found
But with only about 50,000 members in its health plans, Advantage never has grown to be a significant source of patients or revenue for St. Vincent.
"This is just dabbling," she said of St. Vincent's MissionPoint effort so far.
MissionPoint hopes to save money by focusing on the roughly 5 percent of patients with the greatest needs. These are patients already undergoing significant treatment in the hospital or the emergency room. Or they could be patients whose health records show a high risk for a major medical procedure.
MissionPoint assigns nurses to patients coming out of the hospital or the ER to make sure they understand their discharge instructions (Asher noted that most patients can recall only 20 percent of discharge instructions) and to make sure patients get the prescription drugs or follow-up doctor's visits they need.
On top of that, MissionPoint has a team - social workers, mental health counselors, human services professionals and even handymen - to help patients at high risk of hospitalization. These patients are often frail, elderly or poor or suffer from mental health problems - or a combination of those factors.
"We really spend a lot of time working with those patients in need," Asher said. "The majority of those issues are life issues. You can't begin to work on your diabetes or heart disease if you're worried about who's going to pick you up and take you to the doctor or who's going to feed your dog while you're gone."
To help with those efforts, St. Vincent is converting 20 percent of its physician practices - covering about 180 primary care physicians - to a team-based model by next year.
The idea is to have St. Vincent physician practices that don't just prescribe medications, but instead help patients navigate the other parts of the health care system and solve challenges at home.
St. Vincent envisions six of these team-based "medical homes" in or near
St. Vincent's MissionPoint program somewhat resembles what
It partnered with
Local brokers say IU Health Plans has started to gain some traction, although it has kept delaying a big marketing push. It now aims for pitching employers next year.
The biggest chunk of IU Health Plans' business is providing benefits to
IU Health Plans did sign up roughly 1,200 customers on the Obamacare exchanges this year, when it was available in just the
That's a message that resonates with employers, he said.
"There is some degree of significant fatigue that the traditional approaches just aren't creating fundamental improvements," Parker said. "So as we describe our approach and the results that we've had, there's definitely interest."
Services: Works to reduce hospital readmissions and emergency room visits by overcoming patients' barriers to preventive, follow-up and ongoing care. Typically focuses on 5 percent of patients undergoing major-medical procedures or at highest risk of needing them.
Parent:
Founded: 2011
Operating: in seven states, including
St. Vincent partnership: On
Sources:
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