A year after splitting with Blue Cross Blue Shield of Illinois, Springfield (Ill.) Clinic launched its own health plan: Springfield Clinic Advantage.
Chase Hammon, CFO of Springfield Clinic, told Becker's Springfield Clinic Advantage might be the biggest thing the clinic has done in its history.
Springfield Clinic operates 90 clinics in 20 Central Illinois counties. The clinic has been out of network with the state's largest payer, BCBS Illinois, since November 2021.
Though the contract break has lasted longer than a year, the idea to create Springfield Clinic Advantage was around before the dispute, Mr. Hammon said.
"The creation of this was something that we've talked about for a long time," he said. "As the number of calls and complaints have increased, wanting to get in and see us, we sped up the process to really fill that need."
The number of patients affected by the split is contested by the two sides. Springfield Clinic says 110,000 patients are affected, while BCBS Illinois says this number is 55,000.
Despite the disagreements, Mr. Hammon says the system still hopes to restore network status with BCBS Illinois.
"We've got to serve our patients. We've got to serve our community," Mr. Hammon said. "This is the best way we know how to do that."
How it works
Mr. Hammon said the plan is available to any employer but designed for employers with 10 or more employees.
"Springfield is a little bit different in this regard. We have a lot of small employers. We don't have any really big ones," Mr. Hammon said. "We have five or six in the 2,000 to 4,000 range in numbers of employees, and then we have hundreds in the 10 to 100 or 10 to 500 range."
Since announcing the plan on Nov. 29, around 50 local employers have expressed interest in Springfield Clinic Advantage, Mr. Hammon said.
Springfield Clinic partnered with Consociate Health, a Decatur, Ill.-based benefit administration company, to manage the plan.
In addition to Springfield Clinic's network, the plan uses HealthLink, an Elevance Health subsidiary's network. The clinic does not make money from the health plan.
New provider-sponsored plans
A spokesperson for the Alliance of Community Health Plans, which represents several nonprofit payers, said they were unable to comment on Springfield Clinic's plan directly.
A 2018 Health Affairs report found at least 40 provider-sponsored health plans have been launched since 2010.
Provider-sponsored health plans can face challenges gaining enough enrollees to manage risk and compete with bigger payers in the market, according to a 2017 analysis from the Robert Wood Johnson Foundation.
To combat some of these challenges, many providers have opted to team up with existing big payers or community plans to sponsor new plans, according to Health Affairs.
"We don't expect that to be a challenge," Mr. Hammon said. "This is what Consociate [Health] does. This is the model that they work under, and that they have proven year over year that they're very good at."
Mr. Hammon said the benefit to Springfield Clinic Advantage is providing "white glove" care to the 10 to 20 percent of patients that account for 80 percent of healthcare spending.
"None of the big carriers are focused on those 10 to 20 percent of patients in a real and personal way," he said.