eDocTalk article

Legacy pursuing new strategies with health insurers

March 2013

 

Legacy Health is pursuing new strategies with health insurance plans. This is part of our strategic area of focus to “Create innovative, accessible, high-value delivery models.”

Legacy has a number of new relationships with insurers that should help us build volume and provide more accountable and higher-value care. These relationships are important, since Legacy does not currently have its own health plan.

Cigna “Collaborative Accountable Care”

Our partnership with Cigna is a good example of the way health care is transforming.

We are the only system in the Northwest that is working with Cigna in a type of accountable care it calls “Collaborative Accountable Care.” As with other forms of accountable care, this model makes Legacy responsible for the health of plan members.

It also is built on the familiar idea of the primary care health home that coordinates all of the member’s care.

We have been working in this model with Cigna since early 2012, and it has mostly been available to their members who work at Safeway. So far, Legacy primary care clinics have gained 405 patients.

Legacy physicians are “CommunityCare” preferred providers

Legacy Health and Health Net of Oregon created a joint venture insurance product called CommunityCare. It has a preferred group of providers, primarily Legacy Health’s employed and affiliated physicians and hospitals. The two partners share the insurance premium dollars – and the risk. This gives each an incentive to provide quality, efficient care.

ODS, Regence preferred provider relationships

ODS and Legacy Health, along with Salem Health, have joined in “Systems of Care,” a preferred provider plan that is being offered first as an option to Oregon educators through the Oregon Educators Benefit Board (OEBB) and soon as a product in the open market. In addition, last fall we launched a Medicare Advantage plan with ODS, branded as Legacy Health Medicare.

Legacy Health is one of Regence’s “select” group of plans. In each plan, the specific health care provider is the preferred network. Legacy Select and the others are priced differently and offered to employer groups.

Kaiser and outstanding care

Most recently, you heard about our new relationship with Kaiser Permanente in Clark County, Wash. When Kaiser’s contract with PeaceHealth Southwest Medical Center expires Oct. 1, Legacy Salmon Creek Medical Center will be their “contract” hospital in Clark County. This will mean an increase in average daily census of about 30 patients, and an increase of 1,000 births each year at Legacy Salmon Creek. Emergency visits will also go up.

Kaiser made the move to Legacy Salmon Creek in part because of the high quality of care and high patient satisfaction scores. In fact, it is the care and support all of you deliver every day that is making us successful working with insurers. They recognize that we are a high-performing system, and as our vision statement says, “essential to the health of the region.”

Fierce loyalty to Legacy

Consumers also recognize Legacy’s quality, and they want to be our patients. Many of them, in fact, are fiercely loyal.

Just by way of example, last year a payer decided to eliminate contracts with all providers except Providence. When their members learned they would no longer be able to get care at Legacy clinics or hospitals, the payer received significant feedback from its members. Here is a sample:

  • “We are seriously considering switching health plans because of your move away from Legacy. Staying with our doctors is much more important than staying with our insurance company.”
  • “My family has had health insurance for over 20 years and I just heard you’re dropping Legacy from your insurance plans. I will be changing insurance companies when my renewal comes up.”
  • “I will be canceling my policy since I prefer Legacy. No choice is not a good way to treat your clients.”
  • “Under the flimsy excuse of ‘improving health and lowering costs’, what are you thinking in dropping the Legacy Health system, their doctors, hospitals, and services? They provide the best medical care in the Portland-Vancouver area, and you are dropping them as providers???”
  • “How can telling me that I can’t see my oncologist or primary care provider (who I have been with for 20 years) ever be a good thing?”
  • “Legacy has a trauma 1 hospital. Providence does not! Legacy has a children’s hospital, Providence does not! Did you do your research before you made a decision that will affect thousands?”
  • “Just discovered that Legacy has relationships with 14 other insurance providers. Awaiting our agent’s suggestion(s) of a replacement for your company. At our station in life, we will try to maintain our relationship with Legacy.”

 

This article is a reprint of a February 2013 message from Trent Green, Legacy Health senior vice president, strategic planning and business development, to all Legacy Health employees.

 

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