By Ron VandenBoom
The New West Health Plan may not yet be a money-maker for Northern Montana Health Care. In fact, last year the program lost money. But according to David Henry, president and CEO of the local medical care facility, that's not the primary consideration.
"This program is not as concerned about the profit-driven motive as it is about having people in the plan and shopping locally," Henry said. "I (also) think the consumer has a little bit better working relationship with the provider. ..."
While it's not the goal of New West to lose money, it did in part, Henry explained, because being an insurance carrier is not what medical facilities have traditionally seen as part of their job and because the insurance industry on the whole has experienced hard times and a lot of changes in recent years.
"We have to keep our eyes on it, because it's a change in what we do, ... it's a different wrinkle," he said.
Henry explained that, as medical providers, hospitals have not been "at risk" with private insurance companies. That means that when health care providers send bills to private insurance carriers, there is little risk that they won't get paid and the burden to make money falls on the shoulders of the insurance company, not the hospital.
"Now, with New West," Henry said, "we, as an equity partner, are somewhat at risk for the success of that program."
Wearing both hats -- health care administrator and insurance executive -- creates an interesting dichotomy, Henry said.
"On the one hand, as a hospital administrator, I wish the hospital was busy," he said. "But then from the insurance executive side, I hope nobody gets sick."
Despite its rough beginnings, Henry said he is optimistic about the future of the program, noting that "it seems to be received very well."
"We're learning, we're scrambling to see how ... you can be successful with two different agendas," he said.
He also said he believes it to be good for the state to have competition between insurance carriers, especially since the Legislature forced many insurance providers to leave the state when it required them to write small as well as large group policies.
Henry said the decision to get involved with insurance started several years ago when NMHC actually went out and secured a license. It was, at the time, to be called Big Sky Community Health Plan. After receiving the license, NMHC was introduced to New West Health -- a community-based plan that had been started by three Montana hospitals -- Billings Deaconess, St. Peter's Hospital in Helena and Missoula Community Hospital in Missoula.
NMHC became the fourth equity partner in New West. The group plans only have been for sale in the local market for about eight months. Local agencies handling sales are Steve Mariani Insurance Agency, Erickson-Baldwin Insurance Associates, and Inman Insurance and Real Estate in Chinook.
New West offers up to eight different types of HMO style plans that vary in what they offer from what Henry describes as the Chevy to the Cadillac. It features no cost preventative and prenatal care, no paperwork or claim forms, and the ability to choose your own personal care physician.
The plan also covers out of town referrals and strongly emphasizes preventive health care with features like no charge mammograms, annual exams, and affordable copays for office visits.
So far, Henry said, the program has about 15,000 members state wide with about 1,000 members so far in the Havre region.