Saint Francis Health Plans offers competitive option for healthcare coverage

Friday, April 23, 2021 ~ Updated 5:15 PM

Saint Francis Healthcare System now offers a new option for healthcare coverage — one that works directly with employers on a “provider-sponsored plan” instead of businesses contracting with a third-party insurance carrier.

Launched in August, Saint Francis Health Plans is picking up steam as Saint Francis leadership makes a push in the marketplace. The goal is to help businesses save money with a product that puts control back in the hands of patients regarding the doctor they see and where they receive care.

Saint Francis vice president of medical partners Alex Ogburn told B Magazine that in Southeast Missouri, the vast majority of businesses have 100 or fewer employees. Saint Francis wanted to create a plan that could be clearly administered for both large and small groups and still have all the “bells and whistles” patients have come to expect without breaking the bank.

For most groups with 50 or more employees, Saint Francis offers a standard PPO-based plan. This plan allows a patient to see almost every provider in Southeast Missouri and nationally. Among the provider choices, Saint Francis has “preferential rates to this plan,” Ogburn said.

Additionally, the plan offers aspects of care management and wellness. Wellness and biometric screenings also are included in the plan.

Ogburn gave the example of a patient with multiple chronic conditions. With care management, nurses engage with the patient on education about their condition, their prescriptions and make sure they get to the doctor’s office, among other things. By focusing on maintaining the best possible health, additional care needs may be avoided.

“These are things that we understand should make a difference,” Ogburn said. “We want to make sure that we were taking this on and do it in such a way that it would help members have better health and employers have lower claims.”

Ogburn said over the last five to seven years, Southeast Missouri has seen a proliferation of provider tiering and narrow-network products, meaning patients who might have been treated by a specific doctor for years could be told they had to switch providers or pay significantly more.

“Philosophically, we did not want to do that. With our PPO ‘wide-area network,’ or a ‘broad-area network,’ if an employer accepts our insurance plan, yet their employees still want to go to another hospital, or to another doctor who is not one of ours, that is fine. There is no financial penalty to the employee.”

These provider-sponsored plans are not a new concept, Ogburn said. They were popular 30 years ago before going out of vogue, returning about ten years ago.

“We did our homework and studied what we thought employers wanted in Southeast Missouri,” he said. “And we took a little piece from here, a little piece from there. Our product has a Saint Francis feeling.”

The provider-sponsored plan is not an add-on to an existing insurance plan, unlike some medical savings or wellness programs. It is a competitive offering for employer health insurance.

“We have been able to package it in such a way that our pricing is very competitive with all of those bells and whistles. And so part of what we are seeing is people are starting to get proposals and trying to understand ‘how does this compare?’ And in reality, we have seen we are able to deliver savings.”

Ogburn said savings vary based on various factors, but for a group of 100 people, Saint Francis consistently delivers proposals with savings for its clients.

“Our goal is simple,” he said. “We want our Health Plans to deliver Saint Francis’s nationally recognized quality to employers throughout our region.”

To learn more or request a quote with your specific company information, visit saintfrancishealthplans.com