SoutheastHEALTH rolls out health-insurance option to local employers

SoutheastHEALTH has introduced its own health-insurance option to local employers: Southeast First Option Health Plan.

On Tuesday morning, local business leaders and brokers were invited to Isle Casino Cape Girardeau for an informational meeting about the plan.

Ken Bateman, president and CEO of SoutheastHEALTH, led the initiative in an effort to improve the cost of health care services. It is designed for large, self-funded employers with more than 25 employees. The intent is to reduce employer medical and pharmacy benefits spending by improving employee health in a coordinated and integrated provider network.

The plan, Bateman said during his presentation, runs 10 percent to 20 percent lower than current market pricing and lowers pharmacy costs by 6 percent to 18 percent.

HealthSCOPE Benefits is the plan administrator for Southeast First Option Health Plan.

The plan is a three-tiered system not unlike other insurance programs. Tier one providers are Southeast Hospital and associated clinics, associated SoutheastHEALTH physicians and all participating physicians in Cape Girardeau and surrounding counties.

Tier two providers are part of the Aetna Network or Healthlink PPO. Tier three consists of out-of network health care providers.

The plan is designed in part to increase business for the hospital by excluding local competitors. It is also designed, unlike traditional insurance plans, to lower the cost of employee health care by improving employee health.

According to Jim Bode, CEO of Guiding Life, high deductibles in health care keeps employees from seeing doctors. Through this plan, the health risks of each employee are identified through advanced biometrics offered through Guiding Life, allowing employers the ability to strategically address their risk, and allowing employees to identify plans to improve their own health, Bode said.

By improving employee health, employers health care costs go down, said Scott Barnes, vice president of HealthSCOPE Benefits.

"The health of the members reduces the cost of the plan," Barnes said.

Bateman said the catch is organizers of the health plan are looking for employers that will help pass the savings to the employees.

"It has to be a win-win-win. If all you do is keep the savings and the employee sees no change in their copay, no change in their deductible, no change in their plan, then I have thousands of people wondering 'What do I get out of this?'" Bateman said.

"This may not be a perfect plan coming out of the gate," he said. "But if we don't do something to start the conversation ... then it's never going to happen."

bbrown@semissourian.com

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