The case for copay-only health plans — and how to do them right – Becker’s Payer Issues

Bloomington, Minn.-based HealthPartners launched its copay-only well being plan, Simplica NextGen Copay, this 12 months. The plan units costs for in-network care with out a deductible or coinsurance.

Moe Suleiman, senior vp of business enterprise, and Maggie Helms, senior vp, chief information, AI and digital officer, sat down with Becker’s to unpack the trouble — and do it the fitting means.

The pair mentioned there could be misconceptions surrounding copay-only plans. Some might imagine copay-only plans should exchange all present different plan sorts in a portfolio, when that isn’t essentially the case. Copay-only plans also can stand alongside acquainted choices, akin to a tax-advantaged well being financial savings account, so members can have a alternative.

However, Mr. Suleiman mentioned, employers are in search of an alternate as members face price pressures.

“Corporations are saying, ‘What the heck will we do at this level? Can we proceed to water down advantages and improve prices?’” Mr. Suleiman mentioned, including how larger prices might go on the backs of staff. Employers are reaching an “inflection level” the place they really feel as if they’re operating out of choices. A copay-only plan lends itself to transparency, Ms. Helms mentioned.

On the identical time, copays alone don’t routinely promise affordability.

“Should you redirect folks to the flawed web site of care, that can truly add extra visits. It can result in folks bouncing across the system and possibly won’t tackle the affordability downside,” Ms. Helms mentioned.

The staff embedded info and sources for Simplica NextGen Copay into the HealthPartners app and web site. Mr. Suleiman mentioned HealthPartners’ configuration as a well being plan, system and analysis institute allowed for all of these views to be mirrored in digital instruments. The innovation department of HealthPartners encompasses each the care supply group and the insurance coverage plan, enabling dialogue.

“It’s not simply this progressive device that has transparency and supplies insights and help,” he mentioned. “It additionally does it via an underlying scientific perspective.”

Ms. Helms acknowledged how this technique of gauging suggestions can take extra time. “However after we do convey the answer, we are able to trust that it’s top quality,” she mentioned.