Cape Schools' new health plan forces 'buy up' for Saint Francis access

Saint Francis Medical Center officials are expressing disappointment over a Thursday night decision by the Cape Girardeau's public school board that excludes the Cape Girardeau hospital from the district's insurance network unless employees are willing to pay $40 more per month.

The decision saved the district $317,000 for 2014.

When the Cape Girardeau School District Board renewed its insurance policy Thursday evening, it approved a "narrow network" plan offered by Anthem Blue Cross/Blue Shield to cut costs. The school district is one of the largest employers in the county. The plan starts Jan. 1.

Current Anthem plans will remain the same, except without the option of going to Saint Francis Medical Center, Barnes Hospital in St. Louis or facilities owned and operated by these hospitals, according to information from the district. It includes Southeast Hospital and other hospitals in St. Louis.

However, if an employee wishes to include Saint Francis and Barnes hospitals or facilities, he or she can pay an additional $41.30 a month. Otherwise, Saint Francis and Barnes will be out of the network.

If an employee used Saint Francis or Barnes, they would receive only out-of network benefits, according to district information.

The district pays for insurance coverage for 640 employees. About 60 of those policies include spouses and children, assistant superintendent of support services Neil Glass said.

The board voted 4-2 to choose the "narrow network" plan. Board vice president Kyle McDonald and board member Lynn Ware voted against it, and board member Stacy Kinder abstained because of a conflict of interest. McDonald and Ware were unavailable for comment Friday.

If the district had kept its current plan, costs would have risen 16 percent, Glass said. "Eight percent was what we put in the budget for insurance renewal. When that came in, we had to look at other changes and some options."

Saint Francis' Emily Sikes, a spokeswoman for the hospital wrote in an email to the Southeast Missourian: "Saint Francis Medical Center is extremely disappointed in the Cape Girardeau Public School Board's decision to accept Anthem's new insurance plan that makes our facilities and providers out-of network for their employees. We have been flooded with calls and emails from concerned school district employees telling us that they do not want to leave the physicians they have seen for years. We will look for creative ways we can continue to offer excellent care, competitive pricing and a choice to the school district's employees."

In Southeast Hospital's commitment to offer Southeast Missouri high-quality health care at an affordable cost, vice president and chief financial officer of Southeast Hospital Hugh King on Saturday said about a year ago, the hospital signed a contract with Anthem to be in its Blue Preferred Network. At that time, the rate structure or payment structure was fixed, he said.

King said the rumor there were "smoke-filled room" negotiations with the school board over the last few weeks is not true.

"The rates that were quoted were established over a year ago, the contract went into effect Jan. 1 of this year and other businesses in Cape Girardeau have already signed up to offer their employees the choice of the access or the preferred network," he said.

The school board's choice keeps insurance premiums at zero for employees. "We felt this the best option," school board president Tony Smee wrote in an email to the Southeast Missourian. "Nobody is being denied the opportunity to continue care with Saint Francis and its partners. We're a small community with two hospitals with competing interests. Anything that gives one an advantage over the other is going to be a contested issue."

The school district gave each employee a decision, said executive vice president of Southeast Hospital Jim Limbaugh on Saturday. If an employee has an "affection or obligation to Saint Francis," they can decide to keep his or her existing policy and pay about $40 a month, or the employee can decide to use the Blue Preferred Network at no cost, he said.

"This idea that people are going to be shut out is inaccurate," Limbaugh said.

Costs

The traditional plan has a $2,500 deductible and co-pays for $25 for visits to a primary care physician, such as internal medicine, family medicine, obstetrician-gynecologist or pediatrician, Viers said.

Co-pays for a specialist, such as an ear, nose and throat physician, is $50, said Tom Viers, vice president of The Daniel and Henry Co., the district's insurance consultant.

Glass said insurance costs the district $523.42 per employee per month. The narrow network will cost $564.44 per employee per month.

With the 16 percent increase, he said, the total cost to the district would have been $4.65 million a year. The "narrow network" cost will be $4.33 million.

Glass said he hopes with the narrow network, the district will see claims reductions and monthly loss ratios decline. Insurance companies look at what entities pay each month compared to expenses, and the closer expenses get to premiums, the more an entity pays.

Superintendent James Welker said the proposal was presented to the Community Teachers Association Salary and Welfare Committee on Monday.

The district's renewal is Jan. 1, so Welker said meetings will be held in each building starting this week to answer questions and go through the enrollment process.

This is meant to give the district time to get insurance cards out with the Thanksgiving and Christmas holidays coming.

Employee feedback

Kellie Phillips, chairman of the CTA salary and welfare committee and a seventh-grade science teacher at Central Junior High School, said opinions on the decision from organization members have been mostly positive.

She said the cost situation was presented to the group. If the current plan was kept, employees would have to pay for part of their base plan insurance. With the plan approved by the board, teachers can keep the base plan without paying out-of-pocket expenses.

Unfortunately, Phillips said, teachers who use Saint Francis or doctors in the Saint Francis group will have to have pay. She said that can be a hardship on those teachers, because it's an extra $500 a year out of their pockets.

At its October meeting, Phillips said members of the salary and welfare committee were told the district would start looking at insurance options. "Then when we got to the meeting this past Monday, we were presented with this option, and the board voted [Thursday] night," she said.

Barbara W. Thompson, vice president of marketing and foundation at Saint Francis, said in an email the hospital was "excluded from these discussions."

"The school board was told that Saint Francis was not interested in participating. This is not true. Saint Francis was made aware on Tuesday as school district employees began calling the Medical Center and our physicians' offices because they were worried about losing their physicians," Thompson wrote.

Thompson said judging by the emails and phone calls the hospital has received, "the vast majority [of school district employees] are patients of Saint Francis or our medical partners. Nearly 80 percent of the local primary care physicians are affiliated with Saint Francis. This will be a capacity and access issue for the next year."

King said according to Southeast Hospital's numbers, more than half of the district employees were using Southeast Hospital as their primary-care provider. He also said a number of Saint Francis physicians have privileges at Southeast Hospital, keeping them qualified as in-network health-care providers.

School officials and Viers said Anthem negotiated with the hospitals.

Cathy Reiminger, account manager at Daniel and Henry, said the narrow network has existed in other areas of Missouri, but started in Southeast Missouri earlier this year.

Viers, with the insurance consulting firm, said he wanted employees to have a choice, and the only other cost-effective option was United Healthcare, under which Saint Francis "would have been out completely," he said.

"We feel like we picked the best option to bring to the board," Viers said.

Viers said the district used Anthem for "at least a couple of decades" until two years ago, when it switched to Coventry Healthcare. The district went back to Anthem in January, and this is the first renewal since then.

"We handle renewal process and negotiations. We bought in the initial renewal, and it was just under 18 percent," Viers said.

As for what happens from here for district employees who are Saint Francis patients, Thompson said: "We are developing strategies to assist our patients in keeping their relationships with our physicians, even if they are out-of-network. We will be communicating what those strategies are."

Not the first time

This is not the first time a major community employer chose an insurance provider making Saint Francis an out-of-network provider.

The Southeast Missouri State University Board of Regents awarded its 2011 medical insurance package to United Healthcare in a bid that came in $1.6 million cheaper, or 13 percent lower, than Southeast's employee health plan at the time under Anthem Blue Cross and Blue Shield. The switch saved the university about $1.1 million.

United Healthcare's network included Southeast Hospital, but not Saint Francis Medical Center. Anthem's network had included both. The university employed about 1,100 faculty and staff at the time.

Saint Francis Medical Center offered a "prompt pay discount" to Southeast's out-of-network patients who agreed to pay co-pays and deductible amounts within 45 days of getting their hospital bills in exchange for not charging out-of-network financial penalties.

rcampbell@semissourian.com

388-3639

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388-3632

Pertinent addresses:

301 N. Clark Ave., Cape Girardeau, MO

211 St. Francis Dr., Cape Girardeau, MO

1701 Lacey St., Cape Girardeau, MO