By BETSY TAYLOR
Ministry members are among the growing number of health care systems negotiating directly with self-insured employers to provide health care to the companies' employees and their dependents.
Self-insured employers assume the risk for paying health care claims — so keeping costs contained while providing employees with access to quality care is vital.
Dr. Jordan Asher is chief clinical officer and chief innovation officer for MissionPoint Health Partners, a Nashville, Tenn.-based subsidiary of Ascension that describes itself as a population health management and accountable care organization. He said self-insured employers represent a potential $332 billion market that includes 74 million beneficiaries in the United States. Health care systems working directly with employers provide opportunities to move health care "down the road," he said.
The specifics of direct contracts vary, and are tailored to an employer's individual needs. Some employers contract with MissionPoint for on-site health care clinics. Others structure benefits to incentivize employees to get care within a narrow network of providers.
MissionPoint's network includes 9,700 providers across four states. About half are Ascension employees and half are independent physicians and medical groups.
Todd Sauer, Hydromat's customer service repair and rebuild supervisor, get his health care in the Mercy network under a direct service contract between the machine manufacturer and Chesterfield, Mo.-based Mercy.
Typically, for self-insured employers, MissionPoint uses a shared savings model. If there are no savings below a set baseline, then there is no compensation beyond a small per member, per month charge to access MissionPoint services. MissionPoint says it aligns incentives for all those involved to share risk with clients.
Using a population health approach, MissionPoint analyzes data and identifies ways to improve health care quality and lower costs for the people covered by the employer's insurance. It works to eliminate barriers to care and to identify where patients need more resources. An employer, for instance, might opt to offer health coaching to employees who want to work with care providers on weight loss and fitness. "The things that we have found to be beneficial are the things that impact you as a human being versus those that just impact your disease state," Asher said.
MissionPoint — whose largest client is Ascension — says such an approach works. It said in July it had saved Ascension's Nashville-based Saint Thomas Health more than $11 million in health care costs over the last four years. MissionPoint operates in seven states and has more than 250,000 members, Asher said.
Boeing Co., an aerospace company with more than 160,000 employees worldwide, has been attracting notice in recent years not just for its aircraft, satellites and defense systems, but also for its direct contracts with health care systems.
The close collaboration between health care systems and an employer through direct contracting allows the partners to write a contract specific to the health care needs of an employer. The Chicago-based Boeing provides an incentive for employees to choose to get their care from the preferred network of providers. Reduced employee premiums, additional company funding into the employee's Health Savings Account, free generic prescription drugs and free primary care office visits are ways Boeing is prospectively sharing savings from the program with employees.
"It definitely saves money for our employees," said Jeff White, Boeing's director of health care strategy. He said so far about 13,000 Boeing employees are part of a preferred network. An employee with individual coverage saves about $350 to $400 annually if they agree to receive services through one of the networks of preferred providers. Savings for a family is over $1,000 per year.
Negotiating and instituting direct contracts can be complex and expensive, White noted. When working to provide quality health care for employees and to change the delivery model for health care services from fee-for-service to value-based care, being "directly across the table from a hospital system that's providing a lot of care for your members" is a valuable place to be, he said. In a direct contract, health care systems can share in savings if they lower the costs of Boeing's claims by providing better coordinated care, he said.
White said Boeing employs direct contracting in four U.S. markets where it has large groups of employees. Currently, the program is available to nonunion employees and early retirees and certain unions.
Boeing has direct contracts with four accountable care organizations: Mercy Health Alliance in the St. Louis region; Providence-Swedish Health Alliance and the UW Medicine Accountable Care Network, both based in the Puget Sound area; and Roper St. Francis Health Alliance, based in Charleston, S.C.
It plans a fifth direct contracting relationship with MemorialCare Health System in southern California next year, White said.
William Miller, center, a 62-year-old who lives in the Indianapolis area, visits with two MissionPoint Health Partners employees who assist with his care. Nurse Kim Kinney, left, and social worker C.J. Johnson, right, provide care through Nashville, Tenn.-based MissionPoint Health Partners' direct contract with Ascension.
Refining offerings based on data
Mercy started Employer Health Solutions in St. Louis in 2013 to further its regional efforts to contract directly with employers, said Dr. Tracy Riordan. She is Mercy's clinical vice president for Employer Health Solutions and an internal medicine physician.
Riordan said direct contracting isn't new to the system. Mercy started direct-to-employer contracts in the Springfield, Mo., region about two decades ago. She said that the increased focus on population health, with employers trying to understand the needs of their employees and their dependents, has led Mercy to 11 direct contracts with employers through Employer Health Solutions. The company operates five on-site health care clinics and one virtual health care service for six employers, she said.
Some partner with Mercy to gather biometric data on employees and Mercy analyzes that data, while protecting patient confidentiality, to see areas where the overall health of the population can be improved. Employers who use Mercy as a preferred provider look to Mercy for care coordination, advanced by the use of a single electronic medical record for all care, so providers can avoid test duplication.
Smaller employers opt-in
Some small and medium-sized self-insured businesses are getting on board with direct contracts. Hydromat, a manufacturer of precision machines in Maryland Heights, Mo., with 190 employees, has a direct service agreement with Mercy.
Yvon Frigillana, Hydromat's director of human resources, said Hydromat works with an outside vendor that conducts a health screening for employees annually and calculates each employee's wellness score. Those with wellness scores in the most desirable range receive reductions on their premiums. Additional reductions of about 20 percent in deductibles are also available to those that then choose to see providers in Mercy's network. Many co-payments are waived for their Mercy office visits with a $5 co-pay to see a Mercy specialist. Frigillana said, "Is my Mercy utilization up? Oh, yeah."
Mercy has worked closely with Hydromat for two years. Frigillana said Mercy helps Hydromat employees navigate the health system and actively manage their care. For instance, if Mercy sees that an employee often visits an emergency room, a Mercy representative will ask the employee if Mercy can link that employee to a primary care provider, if the person doesn't have one.
A Mercy representative visits employees on-site a few times a year, scheduling Hydromat employees for a routine preventive care appointment, or answering questions about wellness scores and how to improve them.
Mercy provides a "nurse on call" benefit. Employees can contact a nurse with a health care question or for help finding the right location for the level of care they need. The relationship with Mercy currently allows for health care cost avoidance, Frigillana said, with "the hope for (additional) cost benefit down the line."
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