HUMANA ALIGNS WITH SOUTHEAST

After a year of trying to recruit a Cape Girardeau hospital, Humana Health Care Plans this week designated Southeast Missouri Hospital part of its managed-care network.

Southeast didn't sign a contract and didn't have to agree to the designation. Rather than waiting for Southeast or the other Cape Girardeau hospital, St. Francis Medical Center, to join Humana, Humana designated Southeast the Cape Girardeau hospital.

Jeff Andersen, Humana director of operations, said: "Humana can choose who is in our network. Usually that's on a contractual basis, but it doesn't have to be. The hospitals here won't contract with managed care unless it's Blue Cross.

"In this instance we have selected Southeast Hospital to be a member of our provider network," Andersen said. "That does not mean we don't want a contractual arrangement with Southeast or St. Francis."

People with health insurance through Humana now have a financial incentive to go to Southeast rather than St. Francis. For example, under some Humana insurance plans, the company will pay 90 percent of a bill at Southeast and 70 percent at St. Francis.

In response, St. Francis will cut its rates for Humana customers who choose St. Francis. Its president, John Fidler, said St. Francis guarantees that Humana customers won't pay more out of their own pockets for choosing St. Francis.

Fidler said, "We would prefer to give the discount to the person receiving the service."

James Wente, administrator of Southeast, said he was surprised but honored by the designation.

"I understand Humana has done this in other communities," Went said. "It could have been a flip of a coin in Cape Girardeau; Cape Girardeau clearly has two fine hospitals.

"We will try to do a good job for Humana just like we do for any other health insurer or employer in the Cape Girardeau area," he said.

Wente wouldn't speculate on the designation's consequences on Southeast. The hospital hasn't agreed to any discounts or special pricing as part of the designation. Contractual agreements usually include discounts.

Humana has contracts with 11 hospitals and 150 doctors in Southeast Missouri.

The two hospitals here helped organize a network of five hospitals and 200 doctors. They then contracted with Blue Cross-Blue Shield to offer HealthNet Blue, a managed-care-insurance product that competes against Humana's plans.

Andersen said: "We don't want it to appear that we favor Southeast over St. Francis; we would love to work with either one. But we wanted our members to have a participating hospital in Cape Girardeau; that's the main reason."

Humana provides health-care coverage to about 10,000 people in Southeast Missouri, including employees of Missouri, Procter & Gamble, Columbia Sportswear, Jim Wilson Co., and Poplar Bluff schools.

Fidler wasn't surprised by Humana's move.

"It's a basic tactic for these companies: Concentrate business with a few physicians and one hospital, and when they become dependent on the business, then leverage the position for greater discounts," Fidler said. "I feel it makes more sense for physicians and hospitals to work together and still address the needs of the area."