Bloomington-based HealthPartners has carved out space within two existing clinics solely for subscribers who pick “SmartCare,” a new employee health plan with a relatively limited network of doctors and hospitals.
Starting this month, four employers in the Twin Cities are offering the new program, which steers workers to the newly created Maplewood and St. Paul clinics plus an existing medical office in St. Louis Park for primary care.
It’s another example of how health insurers are offering lower premiums when consumers agree to have their care coordinated by a subset of doctors and hospitals — and pay more out-of-pocket to visit other health care providers.
“With SmartCare, it’s a limited clinic choice,” said Laurin Cathey, executive director of human resources at St. Paul Public Schools, one of the employers that’s trying the program. “With the cost of health care skyrocketing as we’ve seen, everybody is coming up with options.”
Tighter networks have long been one way that health insurers can try to control costs, with the limited choice of in-network doctors and hospitals often frustrating patients and raising questions about quality. Proponents say that with a tighter network, health care providers can do a better job coordinating care to both improve quality and save money.
While narrow network health plans have been around for decades, they have been making new appearances in different parts of the Minnesota insurance market over the last several years — particularly in the market where individuals under age 65 buy their own coverage. Even so, the share of employers offering narrow network health plans has been holding steady in recent years at roughly 5 percent in the U.S., according to 2018 survey from the Kaiser Family Foundation.
There aren’t set definitions for what constitutes a tight or narrow network of doctors and hospitals in a health plan. Different insurers have different rules, but many narrow network health plans let patients visit out-of-network health care providers so long as they pay more out-of-pocket.
Among health plans sponsored by employers, the new SmartCare program from HealthPartners is one indicator that some employers are now starting to give the old network strategy a new look, said Bob Radecki, the owner of Benefit Comply, a consulting firm based in St. Paul.
“This is another way of trying to encourage employees to go to a more cost-effective delivery system,” Radecki said.
Narrow networks “have been a hard sell” in employer plans, he said. “But I’m hearing anecdotal evidence that when employees are given a financial incentive, they are choosing narrow networks at a greater rate than they used to.”
Employer plans with tighter networks often come with the label “ACO,” the abbreviation for accountable care organizations. Blue Cross and Blue Shield of Minnesota, Medica and PreferredOne all sell the plans, emphasizing how tighter networks can give designated health systems incentives and tools to operate more efficiently and improve care.
In most cases, employers offer the ACO as an option, meaning workers can opt instead for a plan with more doctors and hospitals at in-network rates.
At St. Paul Public Schools, the district is offering this year three plans that utilize the new SmartCare ACO network, which means employees get in-network primary care from the three SmartCare clinics. In-network specialty care is available at the HealthPartners, Park Nicollet and Children’s Minnesota health systems, said Cathey, the HR executive.
The school district’s health plans can be paired instead with a broad “open access” network that includes systems like Allina and Fairview. Single employees can see premium savings of about $75 per month with SmartCare, Cathey said, while families choosing the option could save nearly $200 per month in premiums.
The new health plan is an outgrowth of a SmartCare clinic in St. Louis Park that opened in 2016 with a goal not just of providing more coordinated care, but also making it more convenient.
Patients talk with nurses upfront about whether their case should be handled by a nurse, a nurse practitioner or a physician. They also talk about whether the visit can be handled over the phone, through online video or whether it requires an in-person office visit. Finally, they talk about the price differences depending on the medical professional who provides the care, and the setting in which care is provided.
About 9 percent of SmartCare visits occur by phone or video, HealthPartners says, and nearly 70 percent of care is provided by registered nurses or advanced practice clinicians.
At the first SmartCare clinic “we’re actually seeing a reduction in total cost in the range of 10 to 20 percent,” said Scott Aebischer, a senior vice president at HealthPartners. “That’s because there’s multiple options available of how you are receiving your care … not every visit is a face-to-face with a physician.”