First Choice / EvergreenHealth Contract: This contract covers EvergreenHealth’s employees and dependents (approx. 6,000 lives) and has been in effect since January 1, 2014. Through benefit design, EvergreenHealth employees have been incentivized to us EHP physicians. We are in final reconciliation of 2014 benefits costs to determine if there is a gainhare payout for EHP members. The EHP gainsharing payout will be qualified by the level of participation in the EHP quality program.
Cigna Contract: The Cigna contract went live July 1, 2014. EHP is one of three network options, along with The Polyclinic and Northwest Physician Network out of Tacoma. About 5,900 lives have been attributed to EHP. This is a gainsharing contract that rewards cost savings and improvements in quality. In addition, Cigna is giving us $1.50 per member, per month to help with our care management work. Part of that money will help pay for the nurse care coordinator. We are actively working the care gaps with primary care clinics along with the quality metrics. Our cost trend to-date has outperformed the benchmark.
Regence Contract: This contract started on January 1, 2015 as a new product in the individual market. To-date, we have seen about 200 members that have selected this product. We anticipate the product moving to the small group market this summer and the exchange in 2017.
We are one of four networks that have different premiums. The other networks include The Everett Clinic, Multicare, and the UW. This contract is a gainsharing arrangement with a case management allowance.
Premera Contract: The board of managers approved an accountable care network contract that is effective January 1, 2016. It is a gainsharing contract in year one moving to risk in subsequent years.
Puget Sound High Value Network : The EvergreenHealth Board recently approved becoming a founding member of the Puget Sound High Value Network that would include EHP, Overlake, Multicare, Virginia Mason, Edmonds Family Practice. First Choice has offered the Puget Sound High Value Network to self-insured employers as a lower price alternative since August 2014. The product uses benefit design to steer insured members to the systems that are in Network. First Choice contracts that are in place for EHP members will apply to this new network.
Health Care Authority – The Puget Sound High Value Network is in final negotiations with the Washington State Health Care Authority for state employees in the Puget Sound Region for benefit year 2016. The intent is to create a narrow network product that will lower the overall cost of care, and improve quality and member experience. There will likely be three network offerings, Puget Sound High Value Network, UW, and Providence. It is anticipated that we will be taking full risk for about 5,000 lives across the entirety of the network.