Highmark pushes members to use lower-cost facilities under new tiered plans
Highmark Inc. has introduced a third health insurance plan in Pennsylvania that seeks to lower premiums by pushing members to choose less expensive hospitals and doctors.
The state's largest health insurer is targeting the north-central part of the state with Community Blue Premier Flex, which offers members a broad network in which to chose hospitals and doctors. But it will try to get members to use lower-cost facilities through financial incentives, which should lead to lower premiums for employers.
“The number one question from businesses is how can we lower our health care costs; this kind of product helps give them cost savings choices,” Steven Nelson, Highmark senior vice president of product, marketing and strategy, said in a written statement. “We estimate that employers can save up to 20 percent on their premium costs depending on the group's current utilization.”
The introduction of Premier Flex follows Community Blue, which Highmark began offering in Western Pennsylvania on Jan. 1, and Choice Blue, which debuted in Erie, Crawford and Warren counties last year.
Premier Flex and Choice Blue use a tiered network to push members toward lower-cost facilities. Community Blue reduces costs by excluding UPMC, the largest hospital system in the region, from its network.
Premier Flex will be offered to companies in Centre, Columbia, Juniata, Mifflin, Montour, Northumberland, Schuylkill, Snyder and Union counties, starting July 1. Highmark has 130,000 members in that region.
The new plan is referred to as a tiered product because it has three benefit levels that affect a member's out-of-pocket costs, depending on which hospital or doctor they choose for medical services.
In the first tier, out-of-pocket costs will be lower at Evangelical Community Hospital in Lewisburg, Lewistown Hospital, Mount Nittany Medical Center in State College, Schuylkill Medical Center's two hospitals in Pottsville, St. Luke's Miners Memorial Hospital in Coaldale and Sunbury Community Hospital.
In the second tier are Berwick Hospital Center and Geisinger Health System hospitals in Danville, Bloomsburg and near Shamokin. Members will pay more to access medical services at those facilities, but not as much as they would at out-of-network hospitals, which are the third tier.
For example, hospital services in the first tier are 100 percent covered after meeting a family deductible of $1,000. In the second tier, hospital stays are covered at 80 percent after a $2,000 deductible. And the third tier, or out of network, will cover 60 percent of costs after a $4,000 deductible.
“You could save 20 percent by implementing this because ... employees are likely to use the lower-cost providers,” Highmark spokeswoman Kristin Ash said.
Highmark could expand Premier Flex to Western Pennsylvania, Ash said.
That could be difficult because UPMC has refused to agree to tiered reimbursement contracts. UPMC has accused Highmark of trying to use its Community Blue plan as a tiered product by telling Western Pennsylvania members that they can continue to access the system's 19 hospitals if they pay more.
Highmark has said UPMC signed contracts that allow the higher payments, but UPMC has refused to treat Community Blue members.
Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or firstname.lastname@example.org.
Add Alex Nixon to your Google+ circles.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Federal appeals courts disagree on Obamacare subsidies
- 10 million Americans sought help to enroll in Obamacare
- Amwell wastewater site to be shut down
- California firm issues nationwide fruit recall
- Financial health tied to perspective on time
- Consumer prices creep up 0.3% in June
- China meat scandal hits Starbucks, Burger King, McDonald’s
- Sluggish growth elsewhere could infect healthy U.S. economy
- New York home to 389K millionaires
- Chrysler recalls up to 792K Jeep SUVs for ignition switch defect
- Judge nixes suit from Empire State Building investors