Visionary health care
IndyStar.com Business
March 23, 2006
Fresh fruit for workers; savings for local provider
By Daniel Lee
daniel.lee@indystar.com
Imagine you're at work and hungry for a midmorning snack.
When you venture to the office vending machines, instead of doughnuts and chips, you find bagels and fresh fruit. And, oh yeah, that same afternoon your employer will host a screening to test your body fat and cholesterol and conduct other health-factor checks.
And if you need a doctor, you can log onto a Web site and check out quality rankings for physicians in your area. In fact, if you choose one of the top docs, you might not have a co-pay.
This is all part of a vision behind a new health-benefits plan meant to transform Indianapolis-based Gateway Medical Resource Alliance from a small insurance player offering niche coverage into a mainline health-benefits provider. Gateway's plan also is the latest version of a new generation of health-insurance products popping up to address employers' growing concern over the rising cost of health care.
Gateway, a physician-owned business with seven employees and $6 million in revenue last year, envisions its plan set to begin this year as a way to improve the quality of care and cut costs for employers and their workers.
Gateway Chief Executive Officer Terrance Kopp said the plan -- called the Quality-Driven Healthcare Partnership -- eventually could become an alternative to traditional health insurance programs offered by providers including WellPoint's Anthem Blue Cross and Blue Shield or M-Plan.
"It's comprehensive, so it covers all medical specialties and any care a patient would need," said Kopp, adding that he hopes to have about 10,000 people in Central Indiana enrolled in the plan by the end of the year.
Gateway is working with the Indiana Employers Quality Health Alliance, a group representing employers with a total of 70,000 workers, including the state of Indiana, the city of Indianapolis and General Motors. Employers want to improve the quality of care and control their health costs, said Dr. Ned Lamkin, president of the alliance.
Gateway's goal is to create coverage for everything from employee screenings and fitness programs to treatments for serious diseases such as diabetes and cancer. Kopp said the new plan could save an estimated 10 percent to 15 percent on total premiums paid by employers and their workers. The average premium for family coverage last year was $10,880, according to the Kaiser Family Foundation.
Gateway's plan uses chart reviews by peer physicians to rank doctors. The top-ranked doctors then would receive higher reimbursements. Patients also may pay no co-pay, or a reduced co-pay, for using top-rated doctors.
Founded in 1995 by three cardiac physician practices, Gateway has offered specialized coverage for flat fees for diseases such as heart disease and cancer. Gateway has expanded to offer services including corporate wellness programs.
Now, in its effort to expand into primary care, Gateway has signed on American Health Network, a large physician practice, for its new plan.
Dr. Ben Park, president and CEO of American Health Network, said Gateway has been successful in lowering costs for its specialized coverage. "So now the objective is to show that that can work on a more broad scale," he said.
As an example, Kopp said, under the new program diabetics may face no payments for doctor visits to help them manage their blood sugar.
"What we're saying to the employers is it's a lot cheaper to pay 100 percent of the costs for that office visit and drugs and avoid the emergency room visit when the diabetic shows up not taking their medication," he said. "What you're doing is creating incentives for the patient to really manage their disease."
But Gateway faces potential hurdles.
Clarian President and CEO Daniel Evans praised Lamkin as a visionary leader in reforming health care but had some reservations about the approach.
"This particular plan is complex and will have to evolve like all pay-for-performance plans to something that is more easily understood by the provider and the patient," he said. "I commend them on a good start, but I expect it to be different in two to three years than what it is today."
Evans added that quality ratings of physicians must be based on objective criteria and worried about having physicians rendering opinions on other physicians' work.
And other benefits companies are developing systems for rating physician performance.
Anthem, for example, is working with the Indiana Health Information Exchange to roll out an experimental program in Central Indiana that pays bonuses to primary-care physicians who meet certain medical standards in treating patients.
Anthem declined to comment on Gateway's plan.
Gateway's approach is raising curiosity among employers.
"We're just interested in seeing how this is rolled out," said Jerry Malooley, director of health policy and plan design and development for Indiana's Personnel Department. "We're very interested in a concept of a very-high-performing, high-quality network of providers."
The state's 32,000 insured employees now may choose among five plans, all either offered or administered by M-Plan or Anthem. Keith Beesley, a lawyer with the personnel department, said the state has made no decisions about the new plan but added that Gateway, like any insurer, may bid for a state contract to offer benefits.
http://www.menshealthonly.com
March 23, 2006
Fresh fruit for workers; savings for local provider
By Daniel Lee
daniel.lee@indystar.com
Imagine you're at work and hungry for a midmorning snack.
When you venture to the office vending machines, instead of doughnuts and chips, you find bagels and fresh fruit. And, oh yeah, that same afternoon your employer will host a screening to test your body fat and cholesterol and conduct other health-factor checks.
And if you need a doctor, you can log onto a Web site and check out quality rankings for physicians in your area. In fact, if you choose one of the top docs, you might not have a co-pay.
This is all part of a vision behind a new health-benefits plan meant to transform Indianapolis-based Gateway Medical Resource Alliance from a small insurance player offering niche coverage into a mainline health-benefits provider. Gateway's plan also is the latest version of a new generation of health-insurance products popping up to address employers' growing concern over the rising cost of health care.
Gateway, a physician-owned business with seven employees and $6 million in revenue last year, envisions its plan set to begin this year as a way to improve the quality of care and cut costs for employers and their workers.
Gateway Chief Executive Officer Terrance Kopp said the plan -- called the Quality-Driven Healthcare Partnership -- eventually could become an alternative to traditional health insurance programs offered by providers including WellPoint's Anthem Blue Cross and Blue Shield or M-Plan.
"It's comprehensive, so it covers all medical specialties and any care a patient would need," said Kopp, adding that he hopes to have about 10,000 people in Central Indiana enrolled in the plan by the end of the year.
Gateway is working with the Indiana Employers Quality Health Alliance, a group representing employers with a total of 70,000 workers, including the state of Indiana, the city of Indianapolis and General Motors. Employers want to improve the quality of care and control their health costs, said Dr. Ned Lamkin, president of the alliance.
Gateway's goal is to create coverage for everything from employee screenings and fitness programs to treatments for serious diseases such as diabetes and cancer. Kopp said the new plan could save an estimated 10 percent to 15 percent on total premiums paid by employers and their workers. The average premium for family coverage last year was $10,880, according to the Kaiser Family Foundation.
Gateway's plan uses chart reviews by peer physicians to rank doctors. The top-ranked doctors then would receive higher reimbursements. Patients also may pay no co-pay, or a reduced co-pay, for using top-rated doctors.
Founded in 1995 by three cardiac physician practices, Gateway has offered specialized coverage for flat fees for diseases such as heart disease and cancer. Gateway has expanded to offer services including corporate wellness programs.
Now, in its effort to expand into primary care, Gateway has signed on American Health Network, a large physician practice, for its new plan.
Dr. Ben Park, president and CEO of American Health Network, said Gateway has been successful in lowering costs for its specialized coverage. "So now the objective is to show that that can work on a more broad scale," he said.
As an example, Kopp said, under the new program diabetics may face no payments for doctor visits to help them manage their blood sugar.
"What we're saying to the employers is it's a lot cheaper to pay 100 percent of the costs for that office visit and drugs and avoid the emergency room visit when the diabetic shows up not taking their medication," he said. "What you're doing is creating incentives for the patient to really manage their disease."
But Gateway faces potential hurdles.
Clarian President and CEO Daniel Evans praised Lamkin as a visionary leader in reforming health care but had some reservations about the approach.
"This particular plan is complex and will have to evolve like all pay-for-performance plans to something that is more easily understood by the provider and the patient," he said. "I commend them on a good start, but I expect it to be different in two to three years than what it is today."
Evans added that quality ratings of physicians must be based on objective criteria and worried about having physicians rendering opinions on other physicians' work.
And other benefits companies are developing systems for rating physician performance.
Anthem, for example, is working with the Indiana Health Information Exchange to roll out an experimental program in Central Indiana that pays bonuses to primary-care physicians who meet certain medical standards in treating patients.
Anthem declined to comment on Gateway's plan.
Gateway's approach is raising curiosity among employers.
"We're just interested in seeing how this is rolled out," said Jerry Malooley, director of health policy and plan design and development for Indiana's Personnel Department. "We're very interested in a concept of a very-high-performing, high-quality network of providers."
The state's 32,000 insured employees now may choose among five plans, all either offered or administered by M-Plan or Anthem. Keith Beesley, a lawyer with the personnel department, said the state has made no decisions about the new plan but added that Gateway, like any insurer, may bid for a state contract to offer benefits.
http://www.menshealthonly.com
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