How Is Network Health Cutting Its Premiums 15%?

Network Health president Christina Severin
Network Health president Christina Severin

Stop the presses! Somebody’s health insurance premiums are actually going down!!

Network Health, a managed care plan owned by Cambridge Health Alliance, has just announced that as of July 1, its Commonwealth Care plan will cut its premiums by 15%. The cut will bring Network Health to the same price level as Celticare, which, with about 15,000 members, had been the only "lowest cost" Commonwealth Care plan. Now both will share that designation.

The announcement is timed to appeal to potential members during the open-enrollment period for Commonwealth Care, the state-subsidized health insurance for people with low and moderate incomes. The Network Health plan currently serves about 44,000 members, who’ll generally see a drop in monthly premiums of between $10 and $30.

WBUR’s Martha Bebinger reported in April that “plans that cover moderate-income residents through Commonwealth Care are holding rates flat by limiting where patients can go, negotiating tougher contracts with hospitals, and with better oversight of the sickest patients.”

In fact, The Globe reported then that the proposed limited-network contract from Network Health excluded all hospitals in the (expensive) Partners HealthCare system except two.

But that was when the news was about holding rates flat. Network Health is going a step further with its 15% cut, and I asked the plan’s president, Christina Severin, today how they were doing it.

She declined to discuss “exclusions,” like the Partners limits reported by the Globe. In general, she attributed the rate cuts to three main factors:

-Network Health had already been working “extremely hard” to control costs. In the current fiscal year, it had already seen zero growth in its medical expenses.

-Of the 15% cut, 10 percent comes through a “high value network”

-and 5% through “medical expense management.”

In other words, 10% from using lower-cost (though still high quality) facilities and 5% through the kind of proactive “care management” that keeps patients in better shape and thus avoids unnecessary expenses.

Christina provided a few telling examples of Network Health’s efforts at care management:

Mind and body: Network Health has a “fully integrated model,” meaning that mental health and social work staff work side by side with medical providers, she said. “And we really believe, based on what we’ve seen to date and what brought us to this 0 percent trend, that this model is highly efficacious.”

Aftercare: Follow-up for people discharged from the hospital, including a particular focus on people considered high-risk for complications. Is the patient clear about which medications to take and when? An RN will go to the patient’s home to make sure. Does the patient know how to care for a post-surgical wound? Same thing: An RN will make a house call to make sure. Is the patient able to get along at home, with enough food, perhaps a ramp if needed? A social worker may check.

Emergency Room: Another example: If a patient has just used the ER and is considered high-risk for using it again, an RN calls to check up. If they’re considered low-risk, an outreach worker will call. The calls might include some education on how to access primary care rather than the ER.

Hot spots: Then there are the 15% of members who need the most medical help and thus cost the most. By managing their care better, Christina said, costs for this population have been cut by about 5% compared to the last fiscal year.

Readers, plausible? Thoughts?

This program aired on June 3, 2011. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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