New health insurance plans announced last week are expected to cost 4 to 10 percent less than current plans for people willing to sign up for fewer choices.
Three new plans will go on sale in July in Western New York, bringing with them a significant shift in the way many patients here receive care as well as how doctors and hospitals provide it.
The new plans emphasize care coordination, disease management and wellness, performance measurement, and payment methods that reward physicians to control costs.
“It’s about the reinvigoration of primary care, a focus on coordination and communication and payment reform,” said Dr. Michael Cropp, chief executive officer of Independent Health.
For years, people have picked their health insurance based largely on which plan offered the broadest choices of doctors and hospitals.
Now, insurers, hospitals and doctors – historically antagonistic and separate groups – are banding together to offer health plans aimed at steering consumers toward insurance coverage with limited choices.
The lower-cost plans reflect a recognition that the health care system must reform itself as pressure builds to control skyrocketing expenses and improve quality.
The narrow networks resemble the controversial cost-cutting restrictions HMOs tried in the 1990s that consumers and doctors rejected.
But experts say there are big differences today, including an attempt to focus on quality and place an emphasis on primary care.
Also, the new plans give participants the choice to spend more for access to additional doctors and hospitals.
“You have choices about the care you want and how much you want to spend,” said Dee Bellanti, director of provider support at BlueCross BlueShield.
The new plans also differ from the past by putting physicians in charge of key decisions, said Dr. Thomas Rosenthal, chief medical officer of the Optimum Physician Alliance.
“It’s about providing the right care at the right place at the right time,” said Rosenthal, who is helping the effort by BlueCross BlueShield.
The new health plans incorporate “tiers” of coverage in which patients pay the lowest out-of-pocket costs, like deductibles and office visit co-payments, if they use a select group of doctors and hospitals.
But patients can choose to pay higher fees if they want to get care from any other medical providers.
Independent Health is rolling out two plans:
• Choice Plus is aimed at businesses with 50 or fewer employees. The plan comes from a partnership with the Catholic Health System, which includes Mercy, Kenmore Mercy and Sisters hospitals, as well as Catholic Medical Partners, the organization that represents the 900 physicians affiliated with Catholic Health.
• Prime Access is also aimed at employers with 50 or fewer workers, resulting from a partnership with the Primary Connection, a group of 180 primary care doctors, including all those in the Buffalo Medical Group. Members of Prime Access pay higher fees if they decline to fill out a health care appraisal with their main physician aimed at encouraging more communication between them.
BlueCross BlueShield is readying one product:
• Align is a health plan that comes from a partnership with the Kaleida Health hospital system and a recently formed group of 500 physicians called the Optimum Physician Alliance. The insurance plan is geared to businesses with fewer than 50 employees but will be offered to all companies.
Like the other plans, Align gives patients a choice: pay one set of fees to get care from Kaleida Health, the Optimum doctors and a select group of other facilities, such as Roswell Park Cancer Institute, or pay higher fees to seek treatment from any other doctor participating with BlueCross BlueShield.
Univera Healthcare is working on similar coverage but has yet to announce it.
The BlueCross BlueShield plan is expected to come with a premium 6 percent to 10 percent lower than current prices, while Independent Health estimates savings of 4 percent to 6 percent for its coverage, officials said.
Rosenthal said doctors must take the lead in moving toward a new model of care.
Primary care physicians include family physicians, internists, pediatricians and geriatricians. They usually are the first doctors patients turn to for regular checkups and sick visits.
Rosenthal, Cropp and others say the current health system needs to better coordinate the care of seriously ill patients, reduce unnecessary hospital admissions and trips to the emergency room, avoid duplicative tests, manage chronic diseases and prod patients to take a more active role in treatment decisions.
“We’ve been working with medical practices that we have identified as performing at a high level. They are getting things right,” Cropp said. “We want to expand the capacity of those practices and transfer their way of working to others.”