Here’s how the typical health plan works.
You go to the doctor, she orders a procedure and then insurance pays for it. The problem with that model is it creates an incentive for doctors and hospitals to order more tests and procedures.
Three major local health organizations are trying a new model that creates an incentive to keep people healthy. And Boeing is the first employer to sign up.
Providence Health &Services and Swedish Health Services have joined forces to create the Providence-Swedish Health Alliance, one of the first accountable care organizations in the country to work directly with employers on health care benefits for employees.
Western Washington Medical Group, which has more than 90 providers and is headquartered in Everett, joined the alliance on Sept. 18.
It’s a tremendous shift in how health care is delivered to employees and has national implications for the future of health care.
Nonunion employees in the Puget Sound area and some union-represented employees and retirees can choose this new option during the annual enrollment for benefits in November. Coverage would begin in January 2015.
Some of the benefits the alliance is offering include: same-day or next-day appointments for urgent primary care and acute care; a concierge service that patients can reach by phone, email or Web; online and mobile access for scheduling appointments, reviewing test results and contacting providers; more options for preventative care and chronic disease management; and tools to help patients choose treatment options.
An accountable care organization is not insurance, although parts of this model feel like it. Boeing pays the organization, and patients still pay premiums. An insurance company handles administrative functions such as filing claims.
Accountable care organizations work by creating incentives for doctors and hospitals when they deliver better care and save money.
This model is a network of doctors and hospitals that band together to take care of a group of patients. It emphasizes preventative care. Patients need to get their care within the network so there’s far more coordination of care, which saves money and is better for the patient.
“We’re the caregivers,” explained Dr. Joe Gifford, chief executive of the alliance. “The providers directly make an agreement with Boeing to keep their employees healthy. That’s a direct relationship between the people giving care and the people paying for it.”
Since the alliance is managing all of the patient care, they can invest money in programs that promote wellness or save money. Gifford said moving away from the fee-for-service model liberates the organization to try new things. For instance, they could install kiosks in the factory, where a worker could get a quick question answered with a nurse or make an appointment.
The network of providers within the alliance includes Providence Regional Medical Center and Swedish Medical Centers and more than a dozen other hospitals and clinics, including The Everett Clinic, The Polyclinic and Group Health Medical Centers in Puyallup and Renton.
The alliance also can work with patients with Medicare and Medicaid.