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United Health, Sutter roll out HMO network
Dan Verel, Business Journal Staff Reporter
Monday, December 3, 2012, 7:07 am
Categories: Employment, Health Care and Senior Living, Industry News, Insurance, Lake Report, Marin Report, North Bay News, Solano Report, Sonoma Report, Top News Item, Top News Stories | No Comments
United Healthcare will roll out its Signature Value Alliance network geared toward smaller employers in all of Northern California in 2013, with Sutter Health serving as the foundation for the HMO product, the Minnesota-based health insurer said.
The network was first launched in Southern California in April of this year, with the aim of offering employers a more specific network of providers in exchange for lower premiums, while still offering access to traditional and deductible HMO plans. It’s geared toward employers with 51 or more employees.
The Signature Alliance product will be available throughout Northern California, including Marin, Sonoma and Solano counties, starting in January. The network includes 27 hospitals and nearly 12,600 physicians and specialists across Northern California, with 1,670 across the North Bay and San Francisco. Other providers will be part of the network, including San Francisco-based physician group Brown & Toland and the San Jose Medical Group. The HMO product will also include high-deductible options coupled with health savings accounts.
Jeff Dooley, senior vice president for United Healthcare in Northern California, said the motivation behind Signature Value product is twofold. For starters, it’s aimed at keeping employer premiums lower while providing an integrated model and data sharing among providers to produce the best outcomes, he said.
Secondly, such smaller or narrow networks are increasingly being used by both insurers and employers to keep costs in check, and carriers are responding by rolling out more HMO options as a means of staying competitive with each other.
“We feel we’ve got a pretty tight network of physicians covering the Bay Area and beyond. It is a smaller network, but it’s an integrated model of delivery that we’ve put together to, quite frankly, compete with some of the lower-cost competitors out there,” Mr. Dooley said.
Such networks could be particularity beneficial for the North Bay, which has one of the highest medical spending rates in the state, according to Keith McNeil, a broker with The SSM Group, an employee benefits agency in Novato.
“The advent of narrow network health plans will definitely help keep costs down. We have seen that in Southern California,” Mr. McNeil said. “The question will be whether local employers who buy insurance for their employees will be willing to make that switch from offering a plan that has a much broader list of providers to one that costs less but has a narrower network.
“It remains to be seen how quickly North Bay employers will make that decision, but since the North Bay is one of the most expensive healthcare areas in the state it might not take that long,” he added.
Bill Gleeson, a senior spokesman for Sutter Health, said the network will ultimately benefit employers.
“Employers and consumers are increasingly seeking high quality and competitive prices, and United’s plan delivers an attractive statewide narrow network of quality providers committed to high value care,” he said.
It’s the second such HMO product to hit the North Bay in as many weeks, with Blue Shield of California recently forming a narrow network around Novato-based Meritage Medial Network and Sonoma County Primary Care.
“If you look at the market, the market is considering lots of different opportunities to drive costs down,” Mr. Dooley said. “There’s ACOs , and this could be considered something along that line.” Accountable Care Organizations are a product of health care reform, seeking to better integrate care between providers and health plans.
“It’s not just a cost issue,” Mr. Dooley added. “We’re also looking at quality.”
United refers to the new network as a “high-performing” network because of its integrated model, which will include data sharing with providers.
“For a lot of medical groups that we have contracts with, that’s really the key,” Mr. Dooley said. “We’re actually going to share data and try and help them provide advanced care. It’s a collaborative approach from United to help them with the data. Our partners are looking to provide data back to us and obviously improve the quality of care of our patients and members.”
While the new network in Northern California will seek to integrate care between plans and providers, it will also help attract insured patients to Sutter Health and other providers in the network.
“They’ve looked at membership leaving their providers, and we’ve said we’ll see if we can help change that,” Mr. Dooley said.
Mr. Gleeson, of Sutter Health, said more collaboration is likely in response to market demands.
“Creative and collaborative new products as this United plan respond to what the market is looking for, and Sutter Health is very open to participating in more of these innovative options,” he said.
Link to article: http://www.northbaybusinessjournal.com/65450/united-health-sutter-role-out-new-hmo-network-for-norcal/
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