Becker's Hospital Review

45 CFO / FINANCE Americans rigging own medical safety nets as health plan costs climb By Morgan Haefner H igh health insurance prices have led a growing number of Americans to bypass commercial health plans and make their own medical safety nets, ac- cording to the Santa Fe New Mexican. While there is little data detailing how many people are replacing health insurance with their own arrangements, data on health- care-sharing ministries and direct primary care offices show those arrangements are growing in popularity. Enrollment in religion-based healthcare cost-sharing plans grew 74 percent from 2014 to 2016, according to Internal Reve- nue Service data cited by the Santa Fe New Mexican. An alliance for the cost-sharing plans said more than 1 million Americans participate in religion-based healthcare cost-sharing plans. Direct primary care clinics, which often do not accept insurance but charge patients a monthly fee for unlimited physician visits, are also on the rise. In the early 2000s, the Direct Primary Care Coalition trade group said there were only a handful of these types of direct care clinics. As of Septem- ber 2018, there are nearly 900, according to the report. n Sharp, Providence Health, MemorialCare collaborate with Aetna for regional health plan By Morgan Haefner T hree Southern California health systems — San Diego-based Sharp HealthCare, Mountain Valley-based MemorialCare and Renton, Wash.-based Providence Health and Services' Los An- geles County facilities — introduced a regional health plan with Aetna Aug. 13. The plan, which includes PrimeCare Physicians group in Bakersfield, Calif., is dubbed Aetna Whole Health-Southern California. The policy will give members in-network access to 51 hospitals, 122 urgent care facilities, and about 1,400 primary care physicians and 8,300 spe- cialists. The new plan is available for self-insured employers and will be avail- able for fully insured employers pending regulatory approval. Aetna's separate plans with each organization will still be available for employers. Under Aetna Whole Health-Southern California, providers' reimbursement agreements will be tied to quality and care costs. The new payment model will reward providers for meeting quality and patient satisfaction measures, including preventive care, chronic care manage- ment, hospital readmission rates and emergency room visits. n 57% of Americans have been surprised by a medical bill, most blame insurers By Julie Spitzer F iy-seven percent of Americans say they've received a surprise medical bill they thought would be covered by insurance, according to a survey conducted by NORC at the University of Chicago. NORC polled 1,002 individuals from a nationally representative sample of Americans using the AmeriSpeak Panel, a probability-based panel NORC designed to be representative of the U.S. household population. Of the respondents who said they'd been surprised by a medical bill, here are the five most common services they were charged for: 1. Physician services: 53 percent 2. Laboratory tests: 51 percent 3. Hospital or other healthcare fa- cility charges: 43 percent 4. Imaging: 35 percent 5. Prescription drugs: 29 percent e survey also asked respondents which groups — payers, hospitals, physicians or pharmacies — are most responsible for surprise medical bills. Here's the proportion of respondents that said each group was "very" or "somewhat" responsible: • Payers: 86 percent • Hospitals: 82 percent • Physicians: 71 percent • Pharmacies: 64 percent n Operator of 22 freestanding ERs files for bankruptcy By Ayla Ellison H ouston-based Neighbors Emer- gency Center, which operates 22 freestanding emergency rooms, has filed for Chapter 11 bankruptcy, ac- cording to the Texarkana Gazette. Neighbors' freestanding ERs are oper- ating as normal throughout the debt re- structuring process, a company spokes- person told the Texarkana Gazette. "All of our 22 centers are remaining open," the spokesperson said. "The bank- ruptcy was filed to prepare for sale." The spokesperson did not give details on the sale of the freestanding ERs, accord- ing to the report. n

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