For policyholders, that means having surgeries at
"I don't like it," said 52-year-old real estate agent. "Not happy at all."
Spencer sees an eye specialist in
Under the new policy, getting care from out-of-network providers would raise Spencer's annual deductible from
"They say they're giving you a choice, but it's not really a choice," said Spencer, who has to decide whether he'll renew his plan by
More than 7,000
Network result of high patient costs
As a group, those patients tend to be sicker than the general population, he said. They have more chronic diseases; they're less likely to see a primary care provider; and they have high rates of emergency room use. They also cycle through the system, seeing different doctors and duplicating costly services, such as lab work and imaging, he said.
Other insurance companies dropped ACA plans after losing millions of dollars, Sorensen said.
The network model requires patients to choose a primary care provider, such as a doctor or nurse practitioner. The provider makes referrals when the patient needs to see a specialist. The doctors' offices share patients' medical records and track the overall health of the patient population, with the goal of increasing preventive care, Sorensen said. That can include things like reminding 50-year-old patients to schedule their colonoscopies. Or making sure pre-diabetic patients know how to reduce their risk for the disease.
To encourage patients to stay in-network,
However, people who get sick or injured when they're traveling can visit emergency rooms or urgent care without paying out-of-network costs, he said. And patients with rare health issues not covered by in-network specialists won't incur those costs either, said Dr.
Kootenai Care Network formed early this year, said
That's a point of confusion, she said. About 40 percent of Kootenai Care Network's in-network providers are directly employed by
Even if Obamacare is repealed after President-elect
Though Kootenai Care Network is only working with
Other providers say they're getting shut out
Out-of-network providers are concerned about losing business from
"We have no ill will toward
"If you're forcing someone to go to the highest-cost provider, I don't see how that helps control costs," he said.
Pleasant View Surgery Center has similar concerns, said Dr.
"If you can't choose where you're going to get care, they can treat you however they want," Lyman said.
The outpatient surgery center opened in 2013, filling a community need at that time for additional operating rooms, said
Kootenai Health Network will consider adding other hospitals and other providers in the future, said Richesin, the president. But that's too difficult to do during the network's start-up phase, she said.
Setting up physician-led committees, creating record-sharing systems and starting to track patients' health on a population level is time-consuming, Richesin said. The network includes a new analytic system that will track patient care and health outcomes, she said.
Comparing the cost of isolated procedures between hospitals isn't really a fair comparison, Richesin and Chambers added.
Spencer, the real estate agent, is weighing his health insurance options for next year.
He's looking into plans from other insurance companies. He's also considering switching to a low-cost plan that provides only catastrophic health insurance, or paying a penalty for not buying health insurance in 2017.
Spencer said he wants more choices than the network provides.
"I don't want to go to a group of doctors they choose for me," Spencer said. "I want to go where I think I can get the best care."
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