This blog post first appeared in the April 2 edition of NASHCO’s newsletter, News from NASHCO. To read the full newsletter, please click here.
STARTING A HEALTH CARE REVOLUTION – Oregon’s Health CO-OP
What would it take for a healthcare company to start a revolution? This is the question that the founders of Oregon’s Health CO-OP asked when the organization was founded in 2010. When they asked their potential customers what they wanted, Oregonians said they wanted something simple and innovative.
Oregonians told the CO-OP very clearly that they wanted better access to doctors by phone and email and to naturopathic primary care. They also said they wanted plans with understandable out-of-pocket costs and no surprises. Paying coinsurance – a percentage of a charge they don’t know up front – is the kind of surprise they didn’t want.
As a result of those conversations, the CO-OP proposed five “SiMPLE” plans to be offered both on and off the exchange marketplace: SiMPLEplatinum, SiMPLEgold, SiMPLEsilver, SiMPLEbronze and SiMPLE HSA. Each parallels the health benefits of the comparable plan specified in the Affordable Care Act, but also includes these features:
• Flat copayments for all medical services, ensuring that members’ out-of-pocket costs are predictable.
• Zero deductible and no co-insurance making healthcare costs transparent and taking the mystery away.
• A rich wellness program with cash incentives for completion of Patient Activation Measures (“PAM”), to encourage healthy habits and an active lifestyle.
On top of these innovations, Oregon’s Health CO-OP took the lead in serving the growing market for naturopathic care. Its plans offer a unique choice of medical doctors or naturopathic physicians for primary care. Its strategy includes working with the state Association of Naturopathic Physicians to credential naturopathic doctors, so they can serve as primary care providers and bill for procedures other insurers currently don’t allow. The CO-OP was the first insurer in the state of Oregon to allow NDs to be primary care physicians.
Is it “simple” to start a revolution? Not exactly, but Oregon’s Health CO-OP is bringing forth a new way to deliver health insurance — promoting transparency, member engagement, and simplicity in the process. Change will not happen overnight, nor will it occur in a vacuum. But Oregon’s Health CO-OP, following the lead of its members, will continue to challenge the old way of doing business for the benefit of all Oregonians.