With 190 providers and 29 years in business, Middletown-based Crystal Run Healthcare entered a new world in December: the EPO agreement.
Short for exclusive provider organization, Crystal Run”™s “focused EPO” has tailored a health plan for small businesses and small providers that is specifically designed to knock 10 percent to 15 percent off the cost of standard coverage. The tradeoff is in reduced out-of-network flexibility.
It could well be the deal of the future.
“It”™s really about creating value,” said Bruce Nash, chief medical officer for Capital District Physicians Health Plan (CDPHP), which began developing the plan in consultation with Crystal Run in June 2008. “It”™s about creating the highest-value care ”“ better care ”“ at a reduced cost. This is part of an active effort to include medical groups in the process.”
Kelly Smith, Albany-based CDPHP”™s director for small business, said the December rollout of the Crystal Run EPO made it difficult to appeal to those who might shift policies at year”™s end. But, she said, “There has been significant interest. We have been working with the chambers and we think that by March it will catch on.”
The product is being offered in conjunction with both the Orange County Regional Chamber of Commerce and the Sullivan County Chamber of Commerce.
“The impetus is to stay ahead of the curve,” said Michelle Koury, Crystal Run”™s chief operating officer. “With health reform, we”™re looking for new and innovative ways to offer services. An opportunity to partner with an insurance provider is an important aspect of the future of health care.”
Even as the federal health legislation wends through the courts ”“ with mixed rulings ”“ Koury said, “The reality is change is coming. We have to improve care and this product has that potential. Philosophically and strategically, this is a direction we have to move.”
Orange and Sullivan counties were selected specifically for this trial by CDPHP, which operates in 24 counties and which was founded in 1984, but which was eager to expand into the region.
“This partnership is a way to test the waters,” Koury said. “Yes, the choice is limited compared to a PPO” ”“ a preferred provider organization ”“ “but that”™s by design. We fully expect the same outcome for patients, but with fewer moving parts to control or manage.”
Koury said she had just received word of signups the night of Feb. 7. Any assumptions about the stoic nature of a practicing internal medicine specialist are out the window: “It”™s very exciting,” she said.
The Crystal Run EPO ”“ a “focused EPO” ”“ also offers:
Ӣ full coverage for preventive-care smears, mammograms, prostate cancer screening, and well-child care;
Ӣ worldwide emergency care coverage;
Ӣ care management services to mitigate health risk and minimize costs; and
Ӣ health and wellness programs.
Among other amenities is the complementary and alternative medicine program, which provides access to 30 percent discounts on services such as chiropractic, massage, yoga and personal training.