How does the CoxHealth Network fit in the health system? We’re the contact point for CoxHealth system with the major insurance companies that use Cox for their health insurance products – United Healthcare, Anthem, Coventry. So when they contract with CoxHealth to negotiate rates, etc., in terms of the hospital system, we’re that negotiating arm for those insurance plans, including Cox HealthPlans, (which is) treated just like the other plans that we deal with. We work to develop new approaches to the market with self-insured employers that may be self-funded and contract directly with the CoxHealth Network.
What does the network encompass and how does it function? CoxHealth Network is made up of the full spectrum of health care providers, everything from the hospital system to primary care physicians to neurosurgeons to home care (to) pediatrics. Our level of integration basically means that a full spectrum of health care providers has pooled together and has agreed to work together to provide … services. Some integrated programs are so integrated that all of the physicians are employed (by the system). Ours is not that way. We have some employee-physicians, some independent physicians and some who are halfway in-between. The physicians are somewhat independent. They want the freedom to practice medicine the way they’ve been trained to practice medicine, not have somebody tell them how to practice medicine, but be able to (access) the background support and (range) of services that are needed.
What brought you to Springfield? I’ve watched this market for a number of years, and it’s very interesting to me to see the size of the medical population. I don’t know how much (Springfield) grows on a daily basis – I know there’s a lot of people who commute here to work – but the medical population is very large. The levels of integration, the healthy competition between the two health systems, I think, make a really nice case study for the future of health care. Because no matter what health care legislation passes on the national level, we’re going to have some really unique products coming in, and it’s going to take some unique trust and bonds between physicians and employers and health systems to put that together.
How do you think health care reform could affect the insurance industry? We think that bundled payments in some form or fashion, whether it’s Medicare or private system, are going to factor in. To deal with bundled payments, you’re going to have to have a very efficient system, yet you’ve got to be able to offer the full range of health benefits. If you were to have heart surgery, for instance, you’d have multiple providers billing you on what we call fee-for-service basis. … A bundled payment model, in its simplest terms, would mean that you would get a bundled lump-sum (bill) for this open-heart surgery. Then, it’s up to that integrated system – physicians, health systems, home care – along with some mechanism to … take that lump-sum payment and deliver it after the fact to the different people involved in the care.
What do people want in network access? Up until now – and I think it’ll always be this way – a lot of companies are looking at price, especially when we’re in a fee-for-service environment. How much is a day in the hospital? How much is a family practice visit? How much is heart surgery? I think that will continue, definitely they’re looking for price. But I think especially in the self-funded market, there’s more and more transparency, and they’re wanting to really see what it’s costing. So from the very beginning, we’re going to have a lot of emphasis on the wellness area. Sometimes that’s an overused word, but different companies are going to want different degrees of involvement with their employees’ wellness. We want to be able to offer them a little bit of wellness – a walking program for employees – or a high degree of wellness – where we help them intervene with health screenings for employees – because we know that probably 95 percent of health care expense is for 5 percent of the population. [[In-content Ad]]
Springfield event venue Belamour LLC gained new ownership; The Wok on West Bypass opened; and Hawk Barber & Shop closed on a business purchase that expanded its footprint to Ozark.
