Plan Watch

Intermountain Health Plan Promises Price Cap To Employers Willing to Make a Commitment

Frank Diamond

SelectHealth, a subsidiary of Intermountain Health, is promising to keep rate increases for large employers at 4% a year from now until 2019, a story that garnered considerable attention when it broke. “Virtually unheard-of” gushed a New York Times article about the program’s rate increases, which are about one-third to one-half less than what employers usually face.

A three-year contract is quite different in the health insurance marketplace. A self-funded administrator will sometimes offer multiple year contracts on administrative fees. And, occasionally, an insurer might impose a cap saying, for instance, that fees will not increase more than 10% for one year. But that’s as far as it goes. “To have something that says for the next three years, here’s your entire health insurance spend for total cost, that’s definitely innovative, and something that employers can look at and say, ‘This is pretty exciting,’” says Scott Schneider, vice president of sales and marketing for SelectHealth.

The new program, called Share, is being offered to large employers in Utah that have 100 or more workers and that are willing to sign up for the multi-year commitment. Seven companies, encompassing 11,000 beneficiaries, have signed up so far. Participating companies are diverse, including a technology start-up, a supermarket chain, a manufacturer, a large county government, some smaller retailers, and a school district.

“We have different kinds of employers represented in the first year of the program, and that’s really exciting for us because we can learn from that, provide outreach, and actually collect biometric data from an organization that has 30 different worksites. We can work with organizations that have different schedules outside of 9 to 5,” Schneider says.

SelectHealth hopes to pull this off by getting full, and in some ways unprecedented, commitments from the major stakeholders: employers, employees, and providers. Employers, for instance, must agree to SelectHealth being the sole insurer for employees, provide employer-match health savings accounts, establish a wellness council, and initiate annual employee wellness reviews. For their part, beneficiaries agree to participate in disease management programs if they suffer from asthma, COPD, diabetes, or congestive heart failure.

The commitments stakeholders make also involve data sharing and transparency. Select­Health will forward “actionable data” to help providers and hospitals improve. In a FAQ for providers, the health plan said it will work closely with clinics and providers to understand their data and reporting needs. The emphasis on transparency means providers will be able to compare themselves to others. “It will take time to fully incorporate this transparency,” the FAQ states. “We intend to allow practices access to view their own data to vet the data internally from November 2015 through June 2016. We will ‘un-blind’ performance information with all participating practices in July 2016.”

SelectHealth officials say the Share program price guarantee will be maintained through savings of about $2 billion over the next five years. That’s quite a challenge, and many will be watching how Share pulls it off. The Times reported that the plan saved $235,000 in 2015 on surgical staplers just by shopping around, and another $639,000 by ensuring that heart attack patients get to the catheterization lab within 90 minutes of landing in the emergency department.

Highly aligned physicians

Most participating providers in Share are not Inter­mountain employees, according to Schneider. “We would call them highly aligned physicians. There are a lot of midsized clinics within the Utah market. They’re very well respected and provide high-value care.”

SelectHealth will tweak and refine Share as necessary, says Schneider.

It all comes down to making it work and for longer than the initial three-year launch. “We intend that this continues in the future for us,” he says.

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