SHARE

800px-Stethoscope
Wiki­media Commons | Courtesy

As of Jan. 1, Pri­ority Health once again pro­vides health insurance for Hillsdale College faculty and staff after spending on claims increased by $1 million last year.

Fol­lowing a two-year hiatus from Pri­ority, Hillsdale left Blue Cross Blue Shield of Michigan to con­sol­idate two plans for in-state and out-of-state employees. The move will avoid a nearly 28 percent increase in health care spending next year in pref­erence to a 12 percent rise.

Hillsdale is working toward imple­menting a wellness ini­tiative for its employees in order to keep them healthy and costs low, as well.

“Pri­ority, they’re a 300-pound gorilla like Blue Cross Blue Shield in Michigan,” Chief Admin­is­trative Officer Rich Péwé said. “They’ve been very com­pet­itive with rates.”

Last year had a larger-than-normal number of indi­viduals with serious ill­nesses and unex­pected surg­eries — cre­ating costs that sur­passed employees’ out-of-pocket max­imums.

“We had a bigger number of those,” Péwé said. “We were using up our fully insured portion quite a bit.”

In com­bi­nation with the rising number of expen­di­tures, dis­covery of BCBS under­writing the college in its favor made for a perfect storm. While the two plans bundled would have cost almost 28 percent more for this year, in 2017 it could have expe­ri­enced up to a 47 percent increase in expenses. The plan for in-state employees would have increased by almost 60 percent.

“It would have been really unaf­fordable across the board to stay with Blue Cross Blue Shield,” Péwé said. “We saw the writing on the wall.”

Péwé said he did not know if the under­writing was a deal to gain the college’s business or a mis­cal­cu­lation in pro­jection.

BCBS pro­vided a statement: “We valued our rela­tionship with the college, but unfor­tu­nately their cost for medical ser­vices was sig­nif­i­cantly higher than the pre­miums, and the parties could not come to an agreement for 2016.”

Finding a less expensive alter­native, the college opted to change its provider to Pri­ority to pay approx­i­mately $430,000 per year more verses BCBS’s increase of $950,000.

Instead of having one health insurance plan for in-state employees and one for out-of-state workers, the college con­sol­i­dated to serve both groups into the point-of-service plan.

The POS plan is similar to the pre­ferred provider orga­ni­zation service Hillsdale held under BCBS. More uni­versal than the health main­te­nance orga­ni­zation plan — the second under BCBS, which can only be used for those in Michigan — the POS plan ser­vices college employees across the United States.

The Pri­ority plan allows employees on campus to go to most of the local clinics around Hillsdale, Michigan, including Hillsdale Hos­pital and Cleveland Clinic. It also covers the hos­pital at the Uni­versity of Michigan, which was added to the network within the past two years. Pri­ority not cov­ering treatment at the Uni­versity of Michigan was a factor in the college leaving their service orig­i­nally.

The POS plan also requires employees to have a primary care physician and go to places within the Private Health Care Systems network or they might have to pay a higher amount. This espe­cially con­cerns those in met­ro­politan areas where a larger market means less pressure to join the Pri­ority web.

“Some of that is def­i­nitely an issue,” Péwé said. “We’re always very con­cerned about that and working with our broker and working with Pri­ority Health to make sure we reach out to those places to see if they want to be a part of the network so that people don’t have to make a switch.”

As for the college faculty and staff, their pre­miums may expe­rience an increase, but their deductible and out-of-pocket pay­ments could decrease. Instead of out-of-pocket being $4,000 a year for an indi­vidual, it will be $3,000 with a deductible of $2,000. For a two-person household or a family of four, the out-of-pocket costs will decrease from $8,000 to $6,000 with a deductible of $4,000.

“People that were in the HMO plan, they had a really high out-of-pocket before,” Péwé said. “This is actually better.”

With the increased health care expenses over the year overall, however, the college is looking to promote wellness among its employees, Péwé said.

“We’re going to have to be more aggressive with bringing on a wellness program to try to improve our spending, try to get it going in the other direction,” Péwé said.

In par­ticular, this means iden­ti­fying signs of serious ill­nesses before they become chronic. The college would give employees who par­tic­ipate in the program a period of time to go to their doctor and have tests run to look at blood pressure, blood sugar, and other risk factors. Doing so could affect workers’ pre­miums.

“Paying attention to that with their physician, it could make a dif­ference,” Péwé said. “We haven’t done that before, and we’re probably long overdue in doing that.”

College Nurse Carol Drews said healthier workers mean lower health care costs.

“Wellness employees have less absences,” Drews said. “Insurance costs come down. It’s just a win-win.”

Plenty of oppor­tu­nities exist for workers on campus to stay active. Faculty and staff, like stu­dents, have access to the Roche Sports Complex and Biermann Center with their ID. Over the summer, employees can take a full-hour lunch if they use it to workout, Aide to the Ath­letic Director Anita Gordon said.

The goal of the wellness ini­tiative is to further promote that healthy lifestyle.

“I’m looking forward to see what the wellness program will look like,” Drews said. “I think that’s what our health care lacks. If we could focus on immu­niza­tions, stress, healthy eating, I think we would spend less on health care.”

This story was updated Feb. 8 at 9:14 a.m. to reflect a later comment received from BCBS.