Several of the other lowest cost areas, including the Salt Lake City region and Hawaii, also have major hospitals and health systems that have been at the forefront of integrated care, in which rules, payment methods and the bureaucracy are designed to foster collaboration among primary care doctors, specialists and nurses. But people who buy the cheapest Salt Lake City plan will not have access to Intermountain Healthcare, the most prestigious system in the area.
Innovative hospital practices do not guarantee cheap insurance. In Rochester, Minn., the home of the Mayo Clinic in the southeastern portion of the state, the lowest priced silver premium is $305, which is above the national median. Although Mayo’s doctors are salaried and the system practices integrated care, its prices are higher than in Minneapolis, said Dannette Coleman, an executive at Medica, the insurer that offers the lowest priced silver plan in that area. Given Mayo’s extensive network of clinics in the region, “you really cannot be in that area in that state if you don’t have the Mayo Clinic Health System in your network,” she said. Mayo officials did not respond to a request for comment.
In eastern Tennessee, cheap premiums are notable because many residents face chronic health issues. Obesity and smoking are common. “We’re the buckle of the stroke belt,” said Kevin Spiegel, president of Erlanger Health System, which is included in the network of the least expensive silver plan in Chattanooga. Blue Cross and Blue Shield of Tennessee was able to offer the lowest silver premiums in the Knoxville and Chattanooga regions — $180 a month for a 40-year-old — by cutting deals with just one hospital system and their doctors in each region, said Henry Smith, the insurer’s chief marketing officer.
“There are competing systems within those two regions to price against,” Smith said. These lowest premium plans are “the narrowest network we have by far.”
Likewise, in western Pennsylvania, Highmark was able to offer the low premium--$164 for a 40-year-old—by omitting nine hospitals and about 3,000 doctors who charge higher prices, according to spokeswoman Kristin Ash. Consumers wanting a wider network will have to pay Highmark 38 percent more a month.
Tue, Feb 11 2014