St. Luke’s gets into the health insurance business. Could it become a monopoly? [The Idaho Statesman] – InsuranceNewsNet | Business Insurance

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St. Luke’s Health System, the largest health care system in Idahois launching its own health insurance plans.

The nonprofit subsidiary, called St. Luke’s Health Plan, will bring new coverage options to residents in the West Central and South Central areas of the state. Enrollment begins in mid-October and plans go into effect in January.

While the new plans won’t change who can receive care at St. Luke’s facilities, the move will put the company in control of both delivery and payment for many of its health services.

So you might ask yourself: Could St. Luke’s uses its health insurance plans to refer patients to its own hospitals and clinics? And, as a result, gain an unfair advantage over other providers?

When St. Luke’s announced its decision to enter the health insurance business in August, we asked Idaho Insurance Department Director dean cameron what he thought. She said yes, St. Luke’s Health Plan certainly can, and probably will, refer patients to providers within the health system’s network. But she said it’s not a concern.

“We think we have every safeguard to make sure it doesn’t turn into a monopoly deal or an abuse of power,” Cameron told the Statesman by phone. “They had to send us documentation to show that consumers would be treated reasonably if they went out of network.”

A spokesperson for St. Luke’s main competitor, San Alfonso Health System in Boisehe declined to comment.

St. Luke's gets into the health insurance business. Could it become a monopoly? [The Idaho Statesman] – InsuranceNewsNet | Business Insurance Allianz 728x90 2022 08

cameron said Idaho is fortunate to have eight companies that offer health insurance plans, including Blue Cross of Idaho Health Services Inc., Molina Healthcare of Idahomountain Health Cooperative, PacificSource Health Plans, Regence BlueShield of Idaho Inc., selecthealth inc. and UnitedHealthcare.

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Additionally, health insurance companies in the state already work with providers to develop competitive contracts.

“Other states are lucky to have one or two health plans,” Cameron said. “Our insurance companies work with providers of all kinds to develop the most competitive contracts, and we want them to do so, because that gives us, as consumers, the lowest price.”

He said St. Luke’s has agreed that it will charge all health insurers the same rate for any particular medical service, even though there is nothing in the law that requires it to do so.

Cameron said the health system has been transparent and cooperative at every step of the process, but will be vigilant to ensure market standards and fair trade practices are adhered to.

“They want to be very obedient to us,” he said. “So I would be surprised if they tried to change that.”

The health system, which has hospitals and clinics across the state, filed its notice of intent to offer health insurance in March with the state health insurance department. The initial coverage area will include ada, adams, Blaine, Boise, Beds, Canyon, Cassia, custer, Elmore, Jewel, OkayJerome Lemhi, lincoln, minidoka, Owyhee, Payette, twin falls, Valley Y Washington counties

matt wolfpresident of the company’s health plan, believes that the combination of health services and insurance will make an already complicated process more fluid.

“St. Luke’s Health Plan will connect the delivery of care with the financing of care, resulting in a simpler and more affordable health insurance option for our communities,” Wolff said in a news release.

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St. Luke’s hospitals and clinics will continue to accept most other health insurance plans, according to the release.

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