What Boeing's health insurance deal with Mercy means for employees

Aug. 15--ST. LOUIS -- Beginning on Jan. 1, most Boeing employees here will be able to choose a new health insurance provider: Mercy Health.

St. Louis will become the second region, along with Charleston, S.C., in which Boeing has contracted directly with a health care system to offer some employees what they say will be less-expensive care coupled with a better experience.

Around 12,000 mostly nonunion employees in the St. Louis area will be eligible for this option.

For employees who choose the "Preferred Partnership," it means they will contribute less from each paycheck to insurance premiums and there will be no copays for primary care visits.

Employees also will have access to a 24/7 call center that will field everything from clinical questions to sorting out a medical bill.

The catch is local employees will be limited to using Mercy physicians in almost all cases. That raises concerns about access to care while traveling or for a child away at school.

"The trade-off is less choice in exchange for lower upfront premiums -- that's sort of the bottom line," Georgetown University professor Sabrina Corlette said.

For some it may sound like an HMO, or health maintenance organization, a once-dominant type of insurance that restricted consumers to a certain network of doctors that, in turn, tried to better coordinate care in an effort to spend premium dollars more effectively.

The ideas are similar, but Mercy's deal with Boeing resembles what is now called an accountable care organization, or ACO, an idea outlined in the Affordable Care Act.

The idea is to improve the health of a particular population while at the same time curbing costs. When both cost and quality objectives are met, there's an opportunity for the health system to earn a greater profit off of this type of arrangement, according to advocates.

"Health plans have been the middleman and taking up some of the dollar that gets spent on health care," said Kelly Devers, senior fellow at the Urban Institute's Health Policy Center.

"If they can cut out health plans and show employers they can manage risk and improve care, there's more on the table, potentially, for them."

To reduce costs, the health system needs to avoid a duplication of tests and share information across specialties to better manage the patient's care, essentially working more as a team.

"So no longer do I tell a patient that has high blood pressure, 'I'll see you back in six months,' and not know if they were seen at a different specialist. I get reports on what their last blood pressure report was within Mercy," said Dr. Tracy Riordan, vice president of employer health solutions at Mercy.

Thanks to electronic medical records, the physicians will be able to see a patient's entire chart, from a test with a cardiologist to a trip to the gynecologist.

But there will be services Mercy can't provide. For example, Mercy does not offer transplant services. When a situation like that arises, employees will be allowed to "go wherever," said Jeff White, Boeing's director of health care strategy.

When it comes to deciding if this is the best option, White said, it all depends on how the employees utilize health care now.

"The real decision for employees to make is how do they use the provider system today and is their doctor in the preferred partnership network," White said. It'll be a "no-brainer" for those already using Mercy physicians, he said.

Children away at school will be required to receive care from the providers in the Mercy Health Alliance network, but exceptions will be made in the case of an emergency, according to Boeing officials. Care also will be covered if an employee is traveling outside of St. Louis and needs emergency services.

"If the child lives outside of the St. Louis area, the employee should consider if the child can regularly access routine or follow-up care from a provider in the Mercy Health Alliance network. Otherwise, the Preferred Partnership may not be the best option," according to a statement from Boeing.

But for some employees in the St. Louis area, this new insurance model will be their only option.

Beginning in March, all of Krey Distributing's 100 employees converted to the new Mercy plan with much of the same benefits that eligible Boeing employees will be able to take advantage of, including the toll-free number.

Steven Busch, owner and president of St. Peters-based Krey, said he's very happy so far with the plan that has resulted in a 20 percent decrease in premiums.

"Basically, you're taking advantage of one network in the St. Louis area and you're getting the best service, the best price, and, to us, it's a much better fit, more personalized service than using a national health insurance organization," he said.

But the limited network was a problem for one employee who has seen a very "specific specialist" outside the Mercy network for a long time. Busch said the company made an accommodation for the employee and will help him pay for the specialist.

In Charleston, S.C., where Boeing has contracted directly with Roper St. Francis Health Alliance, 6,000 employees there are eligible to choose the insurance option.

Samantha Liss -- 314-340-8017

@samanthann on Twitter

[email protected]

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