GVHP Does Complete 360

February 20, 2006
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GRAND RAPIDS — In the past 18 months, a great deal of attention has been given to "consumer-driven health care." The theory behind this school of medical economics suggests that if consumers are given more responsibility for paying for their health treatment, they will become more discriminating about how they use the health care system.

Others in the medical community believe that consumers will forego medical treatment in order to save money. Grand Valley Health Plan falls into the latter camp, and it has a plan to prevent uninsured and underinsured consumers from going without health care.

PrimeCare is a new service offered by the West Michigan health maintenance organization. Patients pay $360 for membership in the program, which entitles them to 12 visits to any of GVHP's six family practice offices and its urgent care facility. A more limited program offers six visits to the urgent care facility for $190.

Ron Palmer, president and CEO of Grand Valley Health Plan, said that his organization has been observing the consumer trend in "what people are calling 'the health care crisis'" for some time. Palmer doesn't believe that encouraging consumerism through health savings accounts and high-deductible health insurance plans actually does anything to control the growing costs of health care; it simply controls the costs for businesses and insurers. The patients are left holding the tab.

"Right now, much of the direction in approaching the cost issue has been to just shift more of the cost onto the individual," he said. "And our concern, on the other side of the equation, was whether this was going to stop people from getting preventive care — because basically, they're going to have to pay for all of it out of their pocket. And when you start looking at someone who has ongoing needs for primary care, this could really get quite expensive."

But instead of letting those medical charges pile up, Palmer believes that too many consumers would be tempted to go without treatment. That might result in a short-term reduction in the use of medical services, but it could worsen the long-term cost issue. Foregoing regular treatment could cause health problems to become so acute as to require a trip to the emergency room, which Palmer said is typically three to four times as costly as a routine office visit. High-deductible plans and HSAs do nothing to encourage regular health maintenance.

"Wait a minute. The way you get at health care issues is to have people manage their health more carefully. And that reduces the higher-cost items, or the need for higher-cost items," he said. "That's being approached backwards in this equation."

Palmer believes that GVHP's PrimeCare, on the other hand, addresses the economic realities of many West Michigan health care consumers.

"We wanted to try to create a methodology where they could, on a pre-paid basis, make sure that they were going to have access to a physician and X-rays and laboratory and all of those other kinds of things … and the biggest concern: children and immunizations."

GVHP has just launched the PrimeCare program, and is promoting it heavily. Palmer said that the organization has been courting businesses that might find this type of pre-paid medical service an attractive alternative to offering no health care coverage. Others might choose to offer it as a supplement to traditional or high-deductible plans.

"There may be some interest on the part of the employers with these really high deductible plans who will pay for this (PrimeCare); then the employee is sort of responsible for that hole in the middle until it hits their deductible," Palmer said.

GVHP designed the program to be appealing to all health care consumers, not just a particular age, health or income bracket.

"I think it probably is a very good match for pretty much anybody," said Palmer, although he admitted that it is perhaps most beneficial to those who are otherwise not covered by any health plan. "They're at significant risk, and this really helps them mitigate that risk."    

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