In light of some comments made in the recent RDN article on PCRMC’s termination of their participation with Mercy Health Plans insurance, I think it is appropriate to further clarify the relationship between St. John’s Health System and Mercy Health Plans.
I think it is also important for everyone to understand the benefits of a fully integrated health system, particularly in light of the health care debate currently being held in Washington.
St. John’s Health System is unashamedly a fully integrated health system, and in fact has been awarded the status of the nation’s No.1 integrated delivery system in 2007 and again for 2009, among a universe of about 535 integrated delivery systems nationwide.
In 2008, we were ranked No. 3. Being an integrated health system means that St. John’s Health System has three main components: Hospitals, an integrated physician group, and a health plans division. The hospitals include St. John’s Hospital in Springfield, our tertiary care main hospital, and five regional hospitals, including St. John’s Hospital-Lebanon, the closest to the Rolla market.
The physician component is St. John’s Clinic, an approximately 470 physician medical group that is physician-led and professionally managed. St. John’s Clinic has been extremely successful in its first 10 years of existence, with accomplishments and national recognition in patient satisfaction, clinical quality and business operations unmatched by any other physician group nationally in such a short time.
The health plans division includes Mercy Health Plans insurance products (formerly called Premier) sold within our region. It also includes our contracting functions wherein we provide direct contracts to large self-insured employers and also contract for our network of physicians and hospitals with various other insurance companies that provide insurance to smaller and medium sized employers and individuals.
This division also includes a nationally recognized medical management program where chronic disease management and case management professionals coordinate and improve outcomes of care for our insured patients.
Mercy Health Plans is a fully owned subsidiary of Sisters of Mercy Health System, the not-for-profit parent company of St. John’s in Springfield and St. John’s in St. Louis, as well as five other Mercy systems in Arkansas, Oklahoma and Kansas.
Mercy Health Plans insurance is sold competitively with other health insurance products in most of these markets, and as such does refer patients to participating physicians, other providers and hospitals.
As I pointed out in my comments to RDN reporter K.C. Kotyk, the MHP network of physicians, other providers and hospitals is large and includes many more highly qualified physicians and other providers than just those employed by St. John’s Clinic, even in Rolla, where there are 29 St. John’s physicians and 32 non-St. John’s employed physicians with offices in Rolla.
In the six counties of Phelps, Pulaski, Dent, Crawford, Maries and Texas, there are 64 non-St. John’s employed physicians in the MHP network of participating providers and 42 St. John’s employed physicians.
It has been suggested that our fully integrated structure that includes our own health plan is somehow a conflict of interest. In fact, it is exactly this structure that allows a fully integrated health system to coordinate and improve the outcomes of care, ultimately holding health care costs down for everyone.
Instead of much of the “profit” of the underwriting and operations of our insurance product going to provide quarterly dividends to stockholders as it does with investor-owned, for-profit insurance companies, it is used to support disease management activities to improve patient outcomes, to add support services for our patients such as “Nurse on Call,” and to align incentives and provide pay-for-performance bonuses to our physicians for providing the best evidence-based care and improving disease outcomes.
It is also used to support the information infrastructure that helps us provide coordinated care, assisted by the nation’s best and most robust electronic health record from Epic Systems.
In the health-care reform discussions occurring in Congress and in national debate, increasingly it is being recognized that the fully integrated health-care system is the model best suited for the future of health care. Studies show that integrated health systems with structures like our own are showing improved health outcomes, and are doing so at significantly lower costs than other care models.
A few weeks ago a very informative and influential article by Dr. Atul Gawande was published in The New Yorker magazine that received much national attention. In this article the great disparity in the costs of care in one region over another was reviewed.
The author examined the reasons that McAllen, Texas, had among the highest health-care cost per Medicare beneficiary in the country ($15,000), while El Paso, Texas, another border community some 800 miles away with virtually identical demographics, had a cost of $7,500 per patient and yet the outcomes of care in almost every measurable indicator were better in El Paso.
The inescapable conclusion of the article was that McAllen has uncoordinated health care and excessive use of tests and procedures, driven by entrepreneurial medicine. El Paso, and many other communities and regions referenced in the article that had even lower costs than McAllen, had much more coordinated health care. The article indicated that health care was less expensive and had better quality when it was provided through what was termed “accountable care organizations.”
These included fully integrated health systems, such as Mayo Clinic, Geisinger Health System, Kaiser Permanente, Marshfield Clinic and Intermountain Health Care (the No. 3 ranked integrated delivery system in 2009), all of which had high quality health care outcomes.
What was not mentioned in the article, but is a matter of public record that can be easily checked is that Springfield, Mo., and the surrounding region is another area that has among the lowest per capita Medicare beneficiary costs in the country. It is likely that the reason for this is the dominance in this market of two not-for-profit integrated health systems — St. John’s Health System and Cox Health System, both of which have their own insurance product.
In about two months St. John’s Health System will be opening a new ambulatory care facility in Rolla. This facility will be like no other health-care facility of its kind in the nation that we are aware of, in that it is designed and built to accommodate and facilitate the future of health care, no matter what form health-care reform takes.
It is designed for patient-centric and physician-efficient care, and the paperless, digital and accountable world. It is clear that health care delivery must change for the better and we are ready to lead the change.
