St. Luke’s Health System, Idaho’s largest health care system, is launching its own health insurance plans.
The non-profit subsidiary, called St. Luke’s Health Plan, will provide new coverage options to residents of the Midwest and Midwest regions of the state. Enrollment begins in mid-October and plans take effect in January.
While the new plans don’t change who can receive care at St. Luke’s facilities, the move will allow the company to control both delivery and payment for many of its healthcare services.
So you might be wondering: Could St. Luke use its health insurance plans to refer patients to its own hospitals and clinics? And exercise an unfair advantage over other suppliers as a result?
When St. Luke’s announced its decision to enter the health insurance business in August, we asked Idaho Department of Insurance Director Dean Cameron what he thought. He said yes, St. Luke’s health plan can certainly send patients to providers within the health system network, and likely will. But he said that was no problem.
“We believe we have every guarantee to ensure that this does not become a monopolistic arrangement or an abuse of power,” Cameron told the Statesman by phone. “They had to submit documents to us to show that consumers would be treated reasonably if they exited the network.”
A spokesperson for St. Luke’s main competitor, Saint Alphonsus Health System in Boise, declined to comment.
Cameron said Idaho is fortunate to have eight carriers offering health 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.
Additionally, state health insurance companies are already working with providers to develop competitive contracts.
“Other states are lucky to have one health plan or two health plans,” Cameron said. “Our insurers work with providers of all kinds to develop the most competitive contracts, and we want them to do this because it gives us as consumers the lowest price.”
He said St. Luke’s agreed to charge the same rate to all health insurers for a particular medical service, although nothing in law requires it to do so.
Cameron said the healthcare system has been transparent and cooperative every step of the way, but will ensure market standards and fair trade practices are followed.
“They want to be very compliant with us,” he said. “So I would be surprised if they tried to change that.”
The health system, which has hospitals and clinics across the state, filed its notice of intent to offer health insurance in March with the state Department of Health Insurance. 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.
Matt Wolff, president of the company’s health plan, believes the combination of health services and insurance will make an already complicated process more transparent.
“St. Luke’s Health Plan will connect care delivery with care financing, resulting in a simpler, cost-conscious health insurance option for our communities,” Wolff said in a press release.
St. Luke’s hospitals and clinics will continue to accept most other health insurance plans, according to the statement.