(WARRENSBURG, Mo.) – The early returns on the Exclusive Provider Option, the new health-coverage product available to UCM employees, have been encouraging, especially in the current financial climate of the university.
Ranea Taylor, associate vice president of human resources, said in the plan’s first month, from Jan. 1 to Jan. 31, the premiums for the university are 6 percent lower than from the same time last year, or about $60,000. She said that number will fluctuate throughout the year, but the early indications are promising.
On an episode of the podcast “America’s Health Care Advocate – Cary Hall,” Ron Rowe, vice president of sales for Blue Cross Blue Shield of Kansas City, said because of the financial projections and the confidence in the plan’s success, BCBS has guaranteed that UCM will not have an increase in premiums for three years, something he said his company has never done. Taylor said premium increases for UCM can be about $1 million annually.
On the program, Rowe said UCM President Chuck Ambrose approached BCBS about a primary medical home for employees of the university two years ago, before the university’s budget had been cut by the state.
Ambrose said healthcare costs have been increasing for years, and something needed to change to allow the university to maintain itself and its employees, especially now that it is forced to operate with less money.
“UCM has been under a tuition cap linked to inflation for ten years,” he said. “And yet we’re being funded by state dollars in an amount lower than what we received in 2001… So, we’re having to budget, simply for our employees, retirement costs and healthcare increases well beyond what we could charge students in increased tuition and/or will get in support. So just those two costs alone wipe out any dollars to improve things, give raises, move people forward. And that’s just not a good model.”
Ambrose worked on developing a partnership among UCM, BCBS, WMMC and Saint Luke’s Health System to develop a plan available to employees that would not only save the university money but also the faculty and staff who participate, and the four institutions entered into an agreement in November 2017.
Taylor said Ambrose’s idea became the model for the new Exclusive Provider Option. Two goals of the EPO were to streamline the transfer of medical data between providers and to promote healthier lifestyles, both of which would lower premiums for both the university and its employees.
She said partnering with Saint Luke’s and WMMC made sense because of the already high rate – 96 percent – of insurance claims coming from those two organizations.
“We have about 1,200 employees,” she said. “If you take 96 percent of the claims amongst those benefit-eligible employees and/or dependents, and they came from two major groupings, it makes sense to partner with those two major groupings, so that’s what we did.”
In the first week of February, WMMC closed one of its clinics and eliminated 41 positions, many of which were filled, in a cost-cutting measure.
Taylor said the hospital cuts won’t impact the relationship between UCM and WMMC or the EPO offered to university employees.
“Any time you have the closure of an organization that is a hospital or a care facility, there’s going to be an impact to the patients of that facility, no doubt,” she said. “Does that impact how our plan operates? No, because our plan still has the structure. The providers that are still there, the operations that are still going on would still bill Blue Cross, [and Blue Cross] would still get the billable dollars. All of the pieces that UCM, from a business perspective, is connected with will continue to move forward.”
Ambrose said the financial burdens experienced by WMMC are part of the business and said he has confidence in the leadership of the hospital.
“The pressures on rural and smaller hospitals are just really intense,” he said. “It’s not easy on smaller hospitals. The federal mandates and the lack of Medicaid reimbursements in the state of Missouri, and a lot of other things, make it a really hard business. That reality will probably never go away… We have a really good working partnership with the senior team [of WMMC]. [WMMC CEO] Derinda Reberry is a very forward-looking administrator and has done a lot of good things, not just for this partnership but for the community.”
Taylor said she understands the level of concern that some participants might have. She said the personal nature of health care, from a patient’s point of view, could make the removal of a particular provider through company downsizing alarming. However, she said there are many reasons WMMC may have chosen to close a clinic that would not necessarily be cause for alarm from a business standpoint.
She said participants in the EPO no longer have copays when visiting their primary care physician and have reduced copays for specialists and reduced costs at pharmacies.
Preventative care is a key part of the plan, Taylor said. The plan includes regular monitoring of certain metrics related to each individual’s health and can be tracked by health care providers. The metrics by which success will be measured are still being defined, but the idea is that if certain metrics are hit and are sustained, the costs of the benefits will go down, both for individuals and for the university.
She said of the five top categories under which most of the UCM employee claims fell, three related to lifestyle choices that increase risks of health issues: cardiovascular, muscular-skeletal and diabetes.
“We can do things with diet and exercise that can significantly impact how many claims we get and how successful people are on the tail end of those types of treatments,” she said.
She said the EPO is about promoting a healthier lifestyle for UCM employees.
“What we have to do as an institution is continue to promote and push the tenets of the program,” she said. “It’s about wellness. It’s about building those relationships with providers. It’s about getting the care, making sure you’re going in and you’re not waiting until you have something like bronchitis… The more you’re getting that care, the more likely you are to not have some of those… really high dollar claims or extended hospital stays. At the same time, you’re developing that relationship with that caregiver, so they’re able to be preventative and proactive, which is really where the cost savings comes from on both sides.”