OKLAHOMA CITY — This year has been tough for state employees and teachers.
Two revenue failures at the state capitol spelled out fiscal hardship for many agencies around our state.
A new program allows state employees to have surgery for free.
“There are many routine things that people need. There’s just no reason why we can’t let people know what that cost is going to be up front,” said Jonathan Small, President of Oklahoma Council of Public Affairs.
When it comes to medical pricing, there is a sense that it`s not fair patients have no way to compare prices as we compare cost and value in every other area of life.
It’s like shopping in a store with no posted pricing.
And to complicate things, the price at the check-out varies, depending on who is paying: the uninsured, those with private health insurance, Medicare or Medicaid.
“We believe everybody ought to attach a price to what they do and be judged on the value that they deliver and create,” said medical pricing transparency advocate Dr. Keith Smith.
There is a movement in Oklahoma, brewing about a decade now, toward price transparency.
It started with Dr. Smith and Surgery Center of Oklahoma.
It has expanded to more than 50 facilities across the state.
They bundle the bill and offer patients an all-inclusive price.
“It’s a win-win,” said Dr. Smith. “All of the non-price-gougers and all of the patients involved in this win. The only losers in this are the people with medical pricing trying to see what they can get away with.”
There is a new player joining the game this year; the state’s largest employer group, state workers.
Health Choice is the largest self-funded insurance plan in Oklahoma with 183,000 covered lives.
“We’re taking a very aggressive approach with the bundled pricing trend here in Oklahoma,” said Administrator Frank Wilson. “We believe there is significant enough savings that it could be a real game changer.”
January 1, 2016 Health Choice launched the Health Choice Select network of providers.
Health Choice Select providers have agreed to a discounted price, and they bundle the bill.
It turns out, that bundled bill is much cheaper, saving the state millions of dollars when patients take advantage.
Since the state is saving big money they are passing along that savings to their members.
If you are covered by Health Choice and if you choose to have your surgery at a Health Choice Select facility, you will pay nothing out-of-pocket for your procedure.
“If there’s an opportunity to save significant money with no out-of-pocket costs to the member it’s a great benefit to the member as well as a great benefit for the taxpayers for the cost of public employee health insurance,” said Wilson. “What we’re trying to do in developing the select program is chose some of the more common procedures that are performed frequently and have the best opportunity for savings.”
Almost every teacher in the state is covered by Health Choice.
Janet Boyd has taught second grade at Chandler Schools for 36 years.
She needed a full knee replacement earlier this year.
“I had no cartilage left. Bone on bone,” Boyd said. “I taught my last year from a stool. I stood up and did the teaching and I sat a lot.”
Boyd’s orthopedic surgeon, Dr. Kevin Hargrove, did her knee replacement at Surgery Center of Oklahoma which is in the Health Choice Select network.
So, Boyd paid nothing for her surgery: no co-pay, no co-insurance, no lab fees, nothing for home health care.
“It’s been shocking and so exciting to tell people,” Boyd said. “Their jaws drop. My jaw dropped because I never have heard of such a thing. How can something this intense be free?”
Janet Boyd could have had free post-operative physical therapy as well, at a Health Choice Select provider.
But, she chose to stay in Chandler and paid the regular charges covered under her Health Choice plan.
Nothing has changed for other in-network providers.
“As dire as teacher salaries are, and the state needs to address that, this is at least some good news for teachers that are facing or planning medical procedures that they are going to get rewarded for good decisions that they’ve made about a provider they chose,” said Small.
Jonathan Small helped change state law so Health Choice Select could operate.
Two years ago, he helped Oklahoma County implement an identical plan. They were actually the first public self-funded plan to offer free surgery to employees who chose a bundled pricing facility.
Oklahoma County has saved $1.7 million in health care costs so far.
County employees have saved $250,000 in out-of-pocket expenses; about $2000 per person per procedure.
“When you think about it, that is going to mean the difference for some families being bankrupt or not,” Small said. “If you have a significant surgery, even if your deductible is capped, most middle-income families cannot afford a $10,000 deductible. Even if the plan is paying 80 to 90 percent of the total cost.”
Wilson won’t go out on a limb yet and guess how much the state might save with the Health Choice Select program.
But, Dr. Keith Smith will.
He believes Oklahoma could save $100 or 200 million a year, which means state employees might get to keep an additional $30 million in their pockets.
“With budgets like they are, other states are watching,” Dr. Smith said. “I can’t imagine the state of Texas watching Oklahoma do something this smart and not respond in a meaningful way. It’s a beautiful thing to watch the market work.”
As more providers join Health Choice Select, and more health plans move toward bundled pricing Oklahoma’s largest hospitals will be forced to join the movement, potentially driving prices down for all.
Health Choice Select Provider List
The Health Choice Select providers network will grow each quarter with a big chunk coming on board January 1, 2017.
Currently, none of the metro’s major hospitals participate.
The hospitals actively lobbied against the change in the law that allowed for Health Choice Select the first year it was proposed and failed.
OU Medical Center has no plans to participate in Health Choice Select in the future. They sent this statement:
At OU Medical Center, our mission is to provide the highest quality, cost-effective care. We provide the most advanced level of care to patients with the most complex medical conditions, no matter their ability to pay.
We do things other hospitals cannot or will not do—for example, our Level I trauma center relies on multiple specialties, highly experienced staff and advanced technology to save lives and restore health, 24 hours a day, 365 days a year.
At this time, we do not plan on participating in Health Choice Select. Most facilities participating are physician-owned, outpatient facilities. Our physicians and hospital are separate and we cannot negotiate on each other’s behalf.
NewsChannel 4 contacted Integris Health, Mercy Health and St. Anthony’s. Those hospital systems would not answer our questions about their intention to bundle prices in the future or participate in Health Choice Select.
A spokesperson for Mercy Hospital told NewsChannel 4 their hospital would be working with the Hospital Association on a strategy for bundled pricing.
Article updated on 12/19/18
