St. Luke’s unveils its own nonprofit medical insurance plan

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St. Luke’s Health System, the biggest health care system in Idaho, is launching its own medical insurance plans.

The nonprofit subsidiary, called St. Luke’s Health Plan, will bring latest coverage options to residents in West Central and South Central areas of the state. Enrollment begins mid-October with plans taking effect in January.

While the brand new plans won’t change who can receive care at St. Luke’s facilities, the move will put the corporate in command of each delivery and payment for lots of its health services.

So you may wonder: Could St. Luke’s use its medical insurance plans to refer patients to its own hospitals and clinics? And wield an unfair advantage over other providers consequently?

0916 stlukes glow.jpg St. Luke’s Health System’s downtown Boise hospital. The health system will soon offer medical insurance plans to Idahoans in 20 counties across the state. Darin Oswald doswald@idahostatesman.com

When St. Luke’s announced its decision to enter the medical insurance business in August, we asked Idaho Department of Insurance Director Dean Cameron what he thought. He said that yes, St. Luke’s Health Plan can definitely, and sure will, send patients to providers throughout the health system’s network. But he said it’s not a priority.

“We consider we now have all of the safeguards to ensure that it doesn’t develop into a monopolistic arrangement or an abuse of power,” Cameron told the Statesman by phone. “That they had to submit documentation to us to point out that buyers can be reasonably treated in the event that they went out of network.”

A spokesperson for St. Luke’s principal competitor, Saint Alphonsus Health System in Boise, declined to comment.

Cameron said Idaho is fortunate to have eight carriers offering medical insurance plans, including Blue Cross of Idaho Health Services Inc., Molina Healthcare of Idaho, Mountain Health Co-Op, PacificSource Health Plans, Regence BlueShield of Idaho Inc., SelectHealth Inc. and UnitedHealthcare.

Plus, medical insurance carriers within the state already work with providers to develop competitive contracts.

“Other states are lucky to have one health plan or two health plans,” Cameron said. “Our insurance carriers work with providers of every kind to develop essentially the most competitive contracts, and we wish them to, because then that offers us as consumers the cheaper price.”

He said St. Luke’s agreed that it would charge all health insurers the identical rate for any particular medical service, although there’s nothing within the law requiring it to accomplish that.

Cameron said the health system has been transparent and cooperative through every step of the method, but he’ll be watching to make sure market standards and fair-trade practices are met.

“They need to be very compliant with us,” he said. “So I can be surprised in the event that they tried to alter that.”

The health system, which has hospitals and clinics across the state, filed its notice of intent to supply medical insurance in March with the state’s medical insurance department. The initial coverage area will include Ada, Adams, Blaine, Boise, Camas, Canyon, Cassia, Custer, Elmore, Gem, Gooding, Jerome Lemhi, Lincoln, Minidoka, Owyhee, Payette, Twin Falls, Valley and Washington counties.

St. Luke’s Health Plan.jpg St. Luke’s Health Plan says its coverage options can be based on a degree of service design. Enrollment within the plans will begin in mid-October. St. Luke’s Health Plan

Matt Wolff, president of the corporate’s health plan, believes that combining health services and insurance will make an already complicated process more seamless.

“The St. Luke’s Health Plan will connect the delivery of care with the funding of care, leading to an easier and cost-conscious medical insurance option for our communities,” Wolff said in a news release.

St. Luke’s hospitals and clinics will proceed accepting most other medical insurance plans, in accordance with the discharge.

Angela Palermo covers business and public health for the Idaho Statesman. She grew up in Hagerman and graduated from the University of Idaho, where she studied journalism and business. Angela previously covered education for the Lewiston Tribune and Moscow-Pullman Each day News.
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