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St. Luke\u2019s Health System grew rapidly over the past decade \u2014 acquiring and making deals with Idaho and Oregon medical practices and hospitals. As it grew, St. Luke\u2019s executives described a master plan to curb the costs of health care \u2014 and to ensure that care actually makes people healthier.<\/p>\n
One milestone in that plan arrived last fall: a new insurance company called St. Luke\u2019s Health Plan.<\/p>\n
\u201cThe thing that really is going to be different with our own health plan: you will have an integrated experience,\u201d said St. Luke\u2019s Health Plan President Matt Wolff. \u201cI think that\u2019s a major hurdle that causes a lot of friction, a lot of dissatisfaction. And frankly, I don\u2019t think it helps us grow trust in the community.\u201d<\/p>\n
The plan is similar in some ways to HMOs like Kaiser Permanente. People with the St. Luke\u2019s insurance card will only be able to get health care services from facilities and health care providers that belong to the St. Luke\u2019s network \u2014 which includes St. Luke\u2019s and other independent providers. It differs from other HMOs, too. For one thing, patients won\u2019t always need referrals from their primary care provider to see a specialist, Wolff said.<\/p>\n
He said St. Luke\u2019s Health Plan promises to be more streamlined to keep patients from getting stuck in Kafka-esque red tape as they try to get healthy.<\/p>\n
Patients won\u2019t get caught between their health insurance company and their doctor when the two disagree, he said.<\/p>\n
The main way it does this, Wolff said, is to leave it up to medical providers to decide what is or isn\u2019t medically necessary. That eliminates the need for \u201cprior authorizations\u201d \u2014 the process for insurance companies to approve or deny medical care before it happens.<\/p>\n
But there\u2019s an internal control on those decisions to control spending, he said: the providers themselves are wholly responsible for the financial and health outcomes of their patients.<\/p>\n
<\/p>\n \t<\/strong><\/p>\n Ten years ago, the St. Luke\u2019s system brought another insurance company into Idaho with what it called \u201ca unique strategic alliance.\u201d<\/a> It partnered with Select Health, a Utah nonprofit insurer, to launch a St. Luke\u2019s-centric plan. That plan from Select Health was, and continued to be, popular with consumers.<\/p>\n The overarching idea of that plan was to reward St. Luke\u2019s and its providers when they made smarter decisions. If they could keep patients healthy, out of the hospital and off costly prescription drugs \u2014 thus controlling the costs for everyone \u2014 St. Luke\u2019s and its providers could see monetary rewards.<\/p>\n Five years into that plan, the Idaho Statesman reported<\/a> that \u201cSt. Luke\u2019s has yet to deliver on its promised savings in insurance premiums.\u201d<\/p>\n Officials said in 2017 that it was \u201ctoo soon to tell whether they can change how health care is paid for and meet their goals,\u201d but they believed they were on the right track, the Statesman reported.<\/p>\n Wolff said the new health plan\u2019s schematic is built on the lessons of that and other \u201cvalue based\u201d insurance arrangements \u2014 which, in 2012, were a somewhat novel approach but are now very common in Idaho.<\/p>\n \u201cAlthough people may talk about integration of having the providers making the decisions, literally that is the case in our model. The St. Luke\u2019s providers and (health care team) ultimately are the ones that are going to say whether these procedures, these visits are necessary or not,\u201d Wolff said. \u201cProviders and the care teams are 100% accountable for clinical and financial outcomes. It doesn\u2019t mean that they\u2019re necessarily going to have to do things that aren\u2019t in line with the care that they think is best, but it does (evaluate the health care) quality of the population, the outcomes in the population, together with a financial responsibility.\u201d<\/p>\n St. Luke\u2019s has faced criticism and even an antitrust lawsuit a decade ago over its growing share of the Treasure Valley health care market.<\/p>\n Wolff said St. Luke\u2019s has no intention of becoming a closed-off system, accessible only to those with a St. Luke\u2019s insurance card. Among the insurers that competed with the St. Luke\u2019s Health Plan on the exchange last fall, nearly all of them had St. Luke\u2019s health care providers and hospitals in their network.<\/p>\n \u201cOur strategy will still be, and always will be, a multi-payer strategy because we don\u2019t believe that one single payer or one single arrangement like that has enough momentum to really change the market,\u201d Wolff said.<\/p>\n Health insurance premiums under the St. Luke\u2019s Health Plan vary depending on a person\u2019s age, where they live, and whether they qualify for a subsidy based on their income. Each person\u2019s out-of-pocket costs will depend on what kind of medical care they need and which plan they choose \u2014 with \u201cbronze,\u201d \u201csilver\u201d and \u201cgold\u201d plans that represent a tradeoff between what you pay each month in premiums versus what you pay out of pocket to use the insurance.<\/p>\n All of the St. Luke\u2019s plans feature a $0 copay for some basics like primary care office visits, on-demand virtual care, outpatient mental health care and prenatal care. They can prevent more costly and complex health problems down the road, Wolff said.<\/p>\n Other health insurers in Idaho also offer no-copay health care services, under the same philosophy.<\/p>\n The Affordable Care Act requires insurers to cover some preventive care at no cost to patients<\/a>. An estimated 862,000 people in Idaho had $0 copay preventive care coverage through private insurance as of 2020, according to a U.S. Department of Health and Human Services report<\/a>. Some of the St. Luke\u2019s Health Plan benefits go beyond those basics.<\/p>\n However, the $0 copay doesn\u2019t always mean a patient won\u2019t have to pay a dime. For example, there is a $0 copay for maternity care. But, as the St. Luke\u2019s Health Plan brochure explains<\/a>, that copay applies to the bill for the OBGYN or other maternity care provider. It doesn\u2019t apply to a facility\u2019s own charges for labor and delivery, which, in a hospital, can run thousands of dollars or more.<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n2023 will test St. Luke\u2019s Health Plan concept<\/h4>\n
St. Luke\u2019s: Health plan not a prelude to shutting out competitors<\/h4>\n
What does it cost? That depends.<\/h4>\n