By Jessica Park
John D. Miles, MD, a surgeon with Columbia Orthopaedic Group, knew there had to be a better way to provide and pay for health care than traditional insurance plans. He wasn’t alone; Dr. Miles and other physicians from Boone Hospital Center’s medical staff joined forces to offer mid-Missouri employers a new option.
The NueHealth Provider Network Priority Access Health Plan, available now to businesses with 2 or more employees, benefits patients, employers, and physicians. The Priority Access Health Plan, or PAHP, allows businesses to provide their employees the health care coverage they need and brings additional value with technology-enhanced features that make it easier to get direct care from their primary care physicians.
The network includes most local private practice physician offices, with primary care providers and specialists from Boone Hospital Center’s medical staff, including Tiger Pediatrics, Columbia Orthopaedic Group and Missouri Heart Center, but doesn’t restrict you from seeing your preferred physicians.
“In mid-Missouri, primary care access for most people is very limited and not readily available,” Dr. Miles explains. As a specialist, this concerned him; limited access to primary care means limited access to specialists, too. The physicians who created this plan wanted to improve primary care access and to provide better value in health care for everyone involved. This improved value includes more transparent pricing for procedures and prescriptions.
The Priority Access Health Plan helps participants establish a medical home, where you can easily talk to physicians familiar with your medical history and needs.
Dr. Miles explains, “This medical home can help you navigate the health system.”
With a traditional plan, even if you have a primary care provider, or PCP, it can be difficult to see your PCP for an urgent medical concern, often requiring a trip to urgent care or the emergency room or waiting days to weeks for an appointment. The PAHP offers different plan levels of priority access to your PCP, similar to a concierge medicine plan, but without the high cost.
All PAHP plans include technology-enhanced features that make it easy for you to get care from your participating PCP without an office visit. Using a HIPAA-compliant, secure app on your phone, you can send your PCP a text message or request a video or voice chat. Within an hour, you’ll be connected to your PCP. Unlike telemedicine, where a contracted physician in another city consults with you, you communicate directly with your doctor or a professional in their office who’s familiar with you and your medical history. If your medical need requires an in-office visit, the PAHP ensures you’ll be seen by your PCP within 24 hours. If you require a referral to a specialist, you won’t wait longer than a week to be seen.
Direct primary care services mean you don’t have to wait for health care. You’ll spend less time going to a doctor’s office, urgent care clinic, or hospital, and you’ll spend less money on urgent care or ED visit copays. (Of course, urgent care and ED visits are covered if needed.) Plus, you can see the physician of your choice.
“We have most private practitioners in Columbia already signed up, but ours is not a narrow network,” Dr. Miles explains. “It doesn’t exclude physicians. We have a wrap network to provide coverage outside of our area, and for services not provided at Boone Hospital.”
The plan also offers health screenings and health risk assessments, and coverage for prescriptions, vaccinations, screenings and various treatments.
An employee who waits for days or weeks to see doctors to treat an illness or pain is not their most productive, so the PAHP benefits employers, too. Technology-enhanced primary care can save employees from taking time off for office visits if their needs can be addressed by text message or video chat.
The PAHP is also more accessible and affordable for local employers. Businesses with as few as 2 employees – or as many as thousands – can participate. For small businesses especially, the PAHP can cost less than traditional insurance options.
“We have a lot of small employers here seeking relief from health insurance premiums, and we think this is going to be able to help,” Dr. Miles explains.
Employers interested in offering the PAHP to their employees should consult with their insurance brokers for a quote, or contact our webpage at priorityaccesshealth.com for more information about the plan.
In traditional insurance plans, primary care physicians are only compensated for patient office visits and often provide hours of uncompensated care. The PAHP compensates PCPs in the network for all your care, whether or not you need an in-person appointment.
“With this model, physicians get to do what they actually like to do in terms of caring for people. Their patient load will be less hectic, and their satisfaction of caring for people will be much higher,” Dr. Miles says.
In the process of developing the PAHP, Dr. Miles learned a lot from many experts. He says, “I knew nothing about health insurance 5 years ago. I owe a lot to many teachers, one of which is Dr. John Bangs, retired Professor of Risk and Insurance at the University of Missouri. He and others got me, and our board, up to speed on the rules of the game and to realize what was possible.”
Critical support and input was derived from the Nuehealth Missouri board of directors including, Vice Chair Don Delwood, MD; Adam Wheeler, MD; Mark Cohen, MD; Michael Cupp, MD; Lee Trammell, MD; Troy Scheidt, MD; Adam Clapper, MD; John Baird, MD; and Bus Tarbox, MD. Boone Hospital joined as a facility partner with the Priority Access Health Plan, and is working with the physicians to bring the best quality, best value health care to mid-Missouri.
While Nuehealth Priority Access Health Plan partners with national third-party administrators, stop loss carriers, managing general underwriters and pharmacy benefits managers, Dr. Miles can’t stress enough that mid-Missouri physicians have led the way on building the plan.
“Boone Hospital Center medical staff doctors have personally funded and developed this program, and we’ve done it on a shoestring,” Dr. Miles says. “Your doctors have made a hometown solution for hometown people.”