Hamilton County to change health care providers, leaving UMR for Anthem
Hamilton County employees will see a change in their healthcare coverage at the start of 2015. Hamilton County Commissioner Steve Dillinger announced the change during a joint meeting with the Hamilton County Council on Sept. 5. The transition to Anthem will begin Jan. 1.
“Anthem agreed to take us, not in their basic Anthem program, but in their master corporate program that (Eli) Lilly and everyone else is under. There is a huge difference between their two programs,” Dilliger said. “Their president made the exception to allow us into the corporate program.”
There were several factors that Dillinger cited for the necessity to change providers but the biggest was the lack of coverage at local hospitals including Methodist, IU Health and Riley. Dillinger said he talked with other executives including the presidents of UMR and IU Health about the situation.
“At the time we had 56 people from Hamilton County in our program at IU alone so it was going to put our people in a terrible, terrible situation,” Dillinger said. “A change at midyear would have been very difficult.”
Dillinger said an eventual agreement was made – retroactively so patients did not lose out on money – but the UMR coverage still caused Hamilton County a lot of problems. Dillinger said the county has had several issues with claims and getting preapproved surgeries on a timely basis.
“I’ve had numerous calls where a surgery was supposed to happen tomorrow and UMR hadn’t approved the surgery yet so we had to push some buttons to make that happen,” he said.
Dillinger said he and the county insurance committee met several times with UMR president Jay Anliker warning him that this had to change “to pretty much no avail.” Dillinger said in past years the county’s claims ratios have been pretty low but in the past six months it has increased including one heart transplant.
“Quite honestly, our employees are getting older, our families are getting older,” he said, adding the county felt it needed to do something to offset the impending financial increase. “In addition to seeing a pretty good increase from our claims ratio our subject trends was like 9 percent and it was going to go up even if our claims had not done anything.”
Dillinger said the county receives a 32-38 percent discount that UMR negotiated with different vendors. However, when looking at the 2015 budget, Dillinger said the county would likely see an increase of more than $2 million because of its trends and experiences.
“Anthem has committed to us, because they have a lot more muscle than UMR, somewhere between 46 and 48 percent,” he said. “Because of switching over to Anthem and getting those larger discounts that has decreased to less than $1 million.”
Dillinger also said IU employees told him Anthem’s claims service was “10 times better than UMR” and should cause fewer burdens on patients.
“Hopefully we’ll have as little a disruption as we can. Anytime you move providers it is a challenge,” he said, adding the county will return to the express prescriptions program
“The net savings is more than $170,000 just in prescriptions.”
In addition to the provider change, Dillinger said employee premiums will remain constant for 2015.
“We talked about that and we decided not to increase employee’s contributions this year because of all the confusion of the switchover,” he said. “It will really enhance our program because on the reinsurance where we had to bid and be reimbursed once we went over our $250,000, Anthem pays it upfront. We don’t have to pay it.”