Bloomington, Minn.-based HealthPartners launched its copay-only health plan, Simplica NextGen Copay, this year. The plan sets prices for in-network care without a deductible or coinsurance.
Moe Suleiman, senior vice president of commercial business, and Maggie Helms, senior vice president, chief data, AI and digital officer, sat down with Becker’s to unpack the effort — and how to do it the right way.
The pair said there can be misconceptions surrounding copay-only plans. Some may believe copay-only plans must replace all existing other plan types in a portfolio, when that is not necessarily the case. Copay-only plans can also stand alongside familiar options, such as a tax-advantaged health savings account, so members can have a choice.
But, Mr. Suleiman said, employers are looking for an alternative as members face cost pressures.
“Companies are saying, ‘What the heck do we do at this point? Do we continue to water down benefits and increase costs?'” Mr. Suleiman said, adding how higher costs could go on the backs of employees. Employers are reaching an “inflection point” where they feel as if they are running out of options. A copay-only plan lends itself to transparency, Ms. Helms said.
At the same time, copays alone do not automatically promise affordability.
“If you redirect people to the wrong site of care, that will actually add more visits. It will lead to people bouncing around the system and probably will not address the affordability problem,” Ms. Helms said.
The team embedded information and resources for Simplica NextGen Copay into the HealthPartners app and website. Mr. Suleiman said HealthPartners’ configuration as a health plan, system and research institute allowed for all of those perspectives to be reflected in digital tools. The innovation branch of HealthPartners encompasses both the care delivery organization and the insurance plan, enabling dialogue.
“It’s not just this innovative tool that has transparency and provides insights and support,” he said. “It also does it through an underlying clinical perspective.”
Ms. Helms acknowledged how this process of gauging feedback can take more time. “But when we do bring the solution, we can have confidence that it’s high quality,” she said.
