Mercy Elects to Offer Own Health Plan

Mercy Elects to Offer Own Health Plan


A COMMUNITY-BASED HEALTH-INSURANCE COOPERATIVE
SAYS IT WILL CONTINUE TO MOVE FORWARD WITH ITS PLANS TO OFFER LOWER-COST HEALTH-CARE
AND INSURANCE PREMIUMS FOR AREA RESIDENTS DESPITE MERCY MEDICAL CENTER’S SURPRISE DECISION
TO PULL OUT OF THE COOPERATIVE’S NEGOTIATIONS. I’M WENDY GRAHAM SETTLE. YOU’RE WATCHING THE LOCAL NEWS NETWORK. SUPPORTERS OF A PROPOSED HEALTH-INSURANCE
COOPERATIVE GATHERED AT MERCY MEDICAL CENTER EARLIER THIS WEEK TO PROTEST CENTURA HEALTH’S
DECISION TO WITHDRAW FROM THE SOUTHWEST HEALTH ALLIANCE. CENTURA HEALTH OWNS 17 HOSPITALS, INCUDING
MERCY MEDICAL CENTER, AND A NETWORK OF CLINICS AND HEALTH-CARE PROVIDERS IN COLORADO AND
WESTERN KANSAS. IN AN AD THAT APPEARED IN THE DURANGO HERALD
AFTER ITS WITHDRAWAL FROM NEGOTIATIONS, CENTURA HEALTH SAID IT WILL LOWER MERCY’S PRICES BY
AT LEAST 20 PERCENT AND WILL WORK DIRECTLY WITH ROCKY MOUNTAIN HEALTH PLANS AND ANTHEM
BLUE CROSS BLUE SHIELD TO LOWER HEALTH INSURANCE PREMIUMS BASED ON ITS LOWER PRICES. I THINK A MORE ACCURATE DESCRIPTION OF THAT
WOULD BE THAT LAST WEEK WE CHOSE NOT TO RESPOND TO THEIR REQUEST FOR PROPOSALS BY THEIR DEADLINE
LAST FRIDAY. I DON’T SEE IT AS WITHDRAWING FROM DISCUSSIONS
WITH SOUTHWEST HEALTH ALLIANCE. I SEE IT MORE SIMPLY, WE JUST CHOSE NOT TO
RESPOND TO THE REQUEST FOR A PROPOSAL. ALL, ALL WE’VE DONE THIS WEEK IS LOWER OUR
HOSPITAL PRICES FOR THE TWO LARGE INSURANCE CARRIERS THAT ARE THE PREDOMINANT DURANGO
CARRIERS FOR LA PLATA COUNTY. NO OTHER CHANGES, NO NEW NETWORK, NO RESTRICTIONS
ON ACCESS, NOTHING DIFFERENT OTHER THAN WE’VE DECIDED TO LOWER OUR RATES FOR COMMERCIALLY
INSURED PATIENTS BY 20%, AND IMPORTANTLY, AND THIS IS A REALLY IMPORTANT POINT, TWO
DAYS AGO, WE DROPPED OUR RATES FOR THE PEOPLE WITHOUT INSURANCE IN THIS COMMUNITY, THERE’S
10,000 PEOPLE IN THE FOUR COUNTIES, FOUR CORNERS REGION THAT HAVE NO INSURANCE FOR WHATEVER
REASON. THEY CHOOSE NOT TO, THEY DON’T HAVE ACCESS
TO IT, THEY CAN’T AFFORD IT. THIS WEEK, TWO DAYS AGO, WE WENT LIVE WITH
NEW PRICING FOR THAT POPULATION. SO WE’VE BEEN ABLE TO HAVE AN IMMEDIATE IMPACT,
NOT FOR THE 5,000, 5,100 PEOPLE THAT WERE PART OF A GROUP-PURCHASING COOPERATIVE FOR
HEALTH INSURANCE. BUT MORE THAN THAT, THE 10,000 FOLKS THAT
ARE WITHOUT INSURANCE TODAY, LEADERS WITH THE SOUTHWEST HEALTH ALLIANCE
SAY THEY ARE ANGRY AND FRUSTRATED WITH THE DENVER-BASED HEALTH-CARE NETWORK AND THAT
THEY FEEL BETRAYED BY THE SURPRISE MOVE. FOR THE LAST YEAR, WE HAVE BEEN WORKING WITH
ALL OF THE DIFFERENT HEALTH-CARE PROVIDERS HERE, INCLUDING CENTURA AND MERCY, INCLUDING
SOUTHWEST MEMORIAL IN CORTEZ AND ANIMAS SURGICAL HOSPITAL, ALL OF THE HUNDREDS OF LOCAL, INDEPENDENT
HEALTH-CARE PROVIDERS, AND LAST WEEK WAS THE BIG WEEK WHERE WE WERE GOING TO FINALIZE THE
NEGOTIATIONS THAT WE, THE COMMUNITY WERE HAVING. AND UP UNTIL THAT POINT, FOR MONTHS, CENTURA
SAID, YEP, WE’LL BE GETTING YOU THAT FEE SCHEDULE. YEP. WE’RE HERE AT THE TABLE, WE’RE LOOKING FORWARD
TO WORKING WITH YOU. AND LITERALLY, AT THE 11TH HOUR WE WERE TOLD, WELL OUR EXECUTIVES
SAID NO. THE SOUTHWEST HEALTH ALLIANCE AROSE FROM A
HEALTH-NEEDS ASSESSMENT CONDUCTED IN 2018 BY LOCAL-FIRST, A NON-PROFIT ORGANIZATION
REPRESENTING LOCAL BUSINESSES, AND THE DURANGO NETWORK, AN ORGANIZATION REPRESENTING LOCAL,
INDEPENDENT HEALTH-CARE PROVIDERS AND ORGANIZATIONS. LOCAL FIRST MEMBERS WANTED THEIR ORGANIZATION
TO TACKLE RISING HEALTH-CARE COSTS THAT WERE IMPEDING EMPLOYERS’ ABILITY TO HIRE AND KEEP
TOP EMPLOYEES. OUT OF THAT EFFORT, LOCAL FIRST DISCOVERED
PEAK HEALTH ALLIANCE, A SUCCESSFUL HEALTH-INSURANCE COOPERATIVE BASED IN SUMMIT COUNTY. PEAK ALLIANCE WORKED WITH LOCAL HEALTH-CARE
PROVIDERS, INCLUING CENTURA’S SAINT ANTHONY SUMMIT MEDICAL CENTER, TO LOWER FEES FOR SERVICES,
AND ARMED WITH THE FEE SCHEDULE AS LEVERAGE, WORKED WITH LOCAL INSURANCE COMPANIES TO LOWER
HEALTH INSURANCE PREMIUMS. THE SOUTHWEST HEALTH ALLIANCE, WHICH INCLUDES
HEALTH-CARE PROVIDERS IN LA PLATA AND MONTEZUMA COUNTY, HAD BEEN WORKING WITH PEAK HEALTH
ALLIANCE FOR NEARLY A YEAR TO NEGOTIATE LOWER HEALTH-CARE FEES FROM LOCAL PROVIDERS WHEN
CENTURA WITHDREW FROM THE NEGOTIATIONS. IN ITS AD PULISHED EARLIER THIS MONTH IN THE
DURANGO HERALD, CENTURA SAID THAT THIRD-PARTY SOLUTIONS LIKE PEAK ALLIANCE DON’T ALWAYS
CORRESPOND TO REDUCTIONS IN CONSUMER COSTS, AND FURTHERMORE, MAY NARROW CONSUMERS’ CHOICES. I THINK THE BIGGEST LESSON, AND I THINK WE’VE
BEEN SAYING THIS ALL ALONG, IS THAT EVERY COMMUNITY SOLUTION IS PROBABLY GOING TO BE
A LITTLE DIFFERENT, AND ONE SIZE DOES NOT FIT ALL. AND WHAT HAS WORKED WELL IN SUMMIT
COUNTY, AND WHERE WE’RE HEADED WITH THAT RELATIONSHIP, WE’D NEVER ANTICIPATED THAT WORKING IN A PLACE
LIKE PUEBLO OR CANYON CITY OR THE DURANGO BECAUSE THE UNDERLYING UNDERPINNINGS OF THOSE
COMMUNITIES ARE VERY, VERY DIFFERENT. THE LOCAL ECONOMIES ARE VERY DIFFERENT. THE EMPLOYER BASE IS VERY, VERY DIFFERENT,
AND SO I THINK THAT HEALTH-CARE SOLUTIONS ARE GOING TO HAVE TO BE TAILORED TO THOSE
COMMUNITIES. SO WE NEVER THOUGHT THAT A ONE-SIZE-FITS-ALL
WOULD WORK. WE’RE PROUD TO BE A PARTNER WITH PEAK HEALTH
ALLIANCE IN SUMMIT COUNTY, BUT WE NEVER ANTICIPATED THAT EXACT MODEL BEING IMPLEMENTED HERE. AFTER THE FIRST YEAR IN BUSINESS, PEAK HEALTH
ALLIANCE LOWERED HEALTH INSURANCE PREMIUMS IN SUMMIT COUNTY BY MORE THAN 20 PERCENT AND
INCLUDED MANY HEALTH-CARE PROVIDERS THAT WERE NOT IN THE CENTURA SYSTEM. WHILE SOUTHWEST HEATH ALLIANCE LEADERS ACKNOWLEDGED
CENTURA’S EFFORTS TO LOWER HEALTH-CARE COSTS, THEY ALSO EXPRESSED CONCERN THAT CENTURA’S
PLAN IS VAGUE, LACKS TRANSPARENCY, AND WILL FURTHER LIMIT CONSUMER CHOICE. THE QUESTION IS, WHAT DOES YOUR ALTERNATIVE
PLAN LOOK LIKE? IS IT A NARROW NETWORK THAT ONLY STEERS PATIENTS
TO MERCY AND TO CENTURA’S HOSPITALS? BECAUSE, IF THAT’S THE CASE, A MONOPOLY IS
NOT THE REALITY OUR COMMUNITY WANTS, AND IT WAS PRECISELY THE COMMUNITY-CRAFTED LOCAL
HEALTH-CARE PLAN THAT WAS ASKING EVERY SINGLE PROVIDER THAT WANTS TO BE AT THE TABLE CAN
SIT AT THE TABLE, AND WE WERE IN THE MIDDLE OF DISCUSSIONS WITH ALL OF THEM. SO IT SEEMS TO ME THAT CENTURA IS MAKING A
CHOICE THAT’S IN THEIR OWN BEST INTERESTS AND THAT ONLY STEERS THEIR PATIENTS AND BUSINESS
AND THEIR BOTTOM LINE TO CENTURA HOSPITALS. CENTURA SAYS IT WILL IMMEDIATELY LOWER PRICES
FOR UNINSURED PATIENTS AND IT HAS POSTED ITS NEW FEE SCHEDULE ON ITS WEB SITE. PATIENTS WHO HAVE INSURANCE WITH ANTHEM OR
ROCKY MOUNTAIN HEALTH PLAN SHOULD SEE A REDUCTION IN THEIR HEALTH-INSURANCE PREMIUMS AND OUT-OF-POCKET
EXPENSES BY MID-YEAR. GESSEL ADDED THAT MERCY’S NEW, LOWER PRICES
ALSO WILL BE AVAILABLE TO CUSTOMERS WHO ARE LOOKING TO PURCHASE HEALTH INSURANCE THROUGH
THE SOUTHWEST HEALTH ALLIANCE, AND HE ANTICIPATES FURTHER CONVERSATIONS WITH THE COOPERATIVE. IN THE MEANTIME, SOUTHWEST HEALTH ALLIANCE
SAYS IT WILL CONTINUE TO PURSUE COST REDUCTIONS WITH A WIDER VARIETY OF HEALTH-CARE PROVIDERS
IN THE AREA. IF MERCY AND CENTURA DON’T COME TO THE TABLE. OUR ONLY OPTION IS TO START LOOKING ELSEWHERE
FOR SOME OF THESE SERVICES, AND IT’LL BE A REAL LOSS WHILE AT THE SAME TIME, UNDERSCORING
THE FACT THAT WE DO STILL HAVE A VIBRANT DIVERSE HEALTH-CARE ECOSYSTEM HERE, AND THAT’S PRECISELY
WHAT WE’RE TRYING TO MAINTAIN. IF YOU’D LIKE TO KNOW MORE ABOUT THE SOUTHWEST
HEALTH ALLIANCE, VISIT FOUNDATION DOT LOCAL FIRST DOT ORG. TO SEE MERCY’S NEW SCHEDULE OF FEES, VISIT
CENTURA DOT ORG SLASH LOCATIONS SLASH MERCY REGIONAL MEDICAL CENTER. THANKS FOR WATCHING THIS EDITION OF LOCAL
NEWS NETWORK. IF YOU’D LIKE TO SEE THIS STORY AGAIN, VISIT
OUR WEBSITE WHERE YOU CAN SIGN UP TO HAVE US DELIVER YOUR NEWS DIRECTLY INTO YOUR INBOX. I’M WENDY GRAHAM SETTLE FOR THE LOCAL NEWS
NETWORK.

Leave a Reply

Your email address will not be published. Required fields are marked *