New county health plan part of a spreading move to opening doors

Oct. 26—A new health care plan announced by Mower County last week not only represents a substantial cost savings for county employees and taxpayers, but also represents a growing shift to a more transparent form of health insurance options.

Last week, it was announced that the Mower County Board of Commissioners approved of the new employee health plan through Self Fund Health and includes a partnership between the county, HELPcare Clinic and North Risk Partners.

The plan, which will be instituted in 2025, will save taxpayers a minimum of $678,000 in comparison to the renewal of its current plan with an overall expected savings of $882,000 for the county.

Just as importantly is the beneficial return for employees that will see more and clearer options to healthcare with far less out-of-pocket expenses.

"What really struck me about this plan is how much it's going to save our employees dollars," said Mower County Human Resources Director Kris Kohn. "HELPcare Clinic is a piece of it, but it's really about having the choice to go places."

"The goal is for employees to not meet their deductible," she added.

The advantages to employees of Mower County are many, including zero dollars spent at Direct Primary Care clinics like HELPCare on things including check-ups, labs and X-rays, physical therapy and more.

It also includes reduced dollars at both in-network and out-of-network facilities for those that want to stay with providers they are familiar and comfortable with.

At the same time, the plan makes use of existing high quality of care requirements established by the Self Fund Health Preferred Network.

"There is no quality out there for people to look at," said Bernie Mackell, risk advisor for North Risk Partners, based out of Wisconsin. "It's there, but it's very hard to get. We're going to give them that."

Self Fund Health requires its Preferred Providers to meet four criteria to become a part of its system.

Healthgrade rating of four stars;

—Provider officers fair and transparent prices;

—Provider must see patients in a timely manner (same day/next day to couple weeks vs. months); and

—Recommended by direct primary care or other independent providers.

"We would argue it isn't an insurance product," said Vice President of Employee Benefits and Risk Advisor for North Risk, Colton Storla. "It's just basic purchasing principles and empowering the employees and their families with the information that they need before going and seeking care."

For direct primary care clinics, like HELPcare, this kind of insurance coverage fits into a basis for providing healthcare. The ability to devote more time at a reduced price.

"When we started we wanted to have a clinic like we have that people can buy membership and be a part of this," said HELPcare Administrator Lee Aase. "We had a vision at that point of being able to serve some of the smaller employers that couldn't afford health insurance, but they could provide a major, significant benefit through a membership with us."

Discussions regarding Mower County's plan started in March at a function both entities were represented at. Following those initial discussions, the county began looking closer at how this kind of arrangement might work.

Kohn said that the plan meets needs of those that perhaps weren't going to receive healthcare because of out-of-pocket costs that were eating into the deductible.

Through this new arrangement, not only are some of these costs mitigated and cost nothing out of pocket, but those taking part can see substantial decreases in what procedures might otherwise cost by making use of a network of other providers recommended by Self Health Fund.

Some of those in the Self Fund Preferred Network include well known institutions like Twin Cities Orthopedics. And of course, it also allows people to stay with current providers, including Mayo Clinic, without an increased price.

"This really opens up opportunities and gives them transparency so they can make decisions," Kohn said. "To be able to offer them something to give them a choice, gives them the opportunity to have better health and for them to be able to afford it. That's the biggest reason we made that move."

This idea of a more financially responsible and transparent healthcare is part of a national trend that's seeing more and more attention across the country, those involved said.

In part because it's being driven by providers who want to be able to spend time with patients without the stress load of high patient volumes resulting in lower visit times.

HELPcare intentionally schedules a low number of patients each day to ensure each patient is seen for more time.

"This is something that is really growing significantly," Aase said. "Our hope is that we're going to be able to do this in more communities in southern Minnesota as well."

This entire process for those Mower County employees that sign up under the plan is guided by a dedicated nurse navigator to Mower County. In this case it's Sarah Mumm, RN, who will help employees with finding the right provider and where best a procedure can be done that fits what the employee wants.

"The nurse navigator is so, so important," Mackell said. "We're going to take that out of their hands and Sarah is going to be their personal shopper. They are going to change the entire framework."

A framework that Mower County staff see as a game changer for their employees.

"It's really not that different from what we really do, it's just we're pulling back the curtain and making it transparent," Kohn said. "Now we have a person that gets paid a flat rate that's doing it out in the open."

"I'm really excited about what this is going to do for our employees and for our taxpayers," Kohn continued. "We always put the employee first. Our people are the most important thing and we are able to model transparency and health care just like Mower County works hard at transparency in government."

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