The systems are changing insurance companies that process claims effective Jan. 1, 2014.
Other area hospital systems Mercy Health and TriHealth, also self-insured, are not changing claims-processing companies, officials with those networks said.
As health providers, Kettering and Premier are impacted by federal health care reform in more ways than one — the law is changing how providers are reimbursed for services and is expected to increase patient volumes.
But like other employers, the nonprofit hospital and doctor groups are also evaluating the costs of their health insurance coverage during annual enrollment time.
Kettering Health is dropping Anthem Blue Cross and Blue Shield, and switching to UnitedHealthcare to administer claims made by covered employees and an additional number of dependents.
Despite the change in insurance company, the health benefits and cost of premiums stay the same for beneficiaries, said Elizabeth Long, spokeswoman for Kettering Health.
Kettering, which has worked with Anthem since 2006, is changing administrators because UnitedHealthcare offers additional wellness programs, Long said.
“Partnering with UnitedHealthcare for our benefit plan allows us to enhance our focus on the health and well-being of our employees and their families. We are working with UnitedHealthcare to implement programs and systems that meet the changing and challenging future of health care for our team members,” Long said in a written statement.
Employers are searching for ways to decrease the trend of rising health care costs, said Kevin Shermach, spokesman for UnitedHealthcare.
“We offer a wide range of incentive-based wellness programs that promote behavior change by rewarding members for making healthy choices and being more personally engaged in improving their health,” Shermach said in an email.
“Our wellness programs provide financial incentives for members who take health assessments, sign up for a telephone-based wellness coaching program, lower their cholesterol, lose weight, or even join a fitness center. Financial incentives can include premium reductions, direct financial contributions to health savings accounts, gym reimbursements, and merchant gift cards,” he said.
Premier Health is dropping UnitedHealthcare and switching to University of Pittsburgh Medical Center to process claims.
Also in 2012, Premier created the subsidiary Premier Health Group. The organization employs care managers, pharmacists and social workers to work with primary care doctors affiliated with the system, as well as population health coaches for some high risk patients.
Beginning in 2014, Premier Health Group is also the provider network for Premier Health employees for their health plan, network officials said.
The health system is also launching Premier Healthy Living, a wellness program for employees.
“Premier Health suffers like every other company with health care costs rising at a rapid rate and they were looking for relief too in trying to get a healthier employee population,” said Dr. Jerry Clark, chief medical officer of Premier Health Group.
When “we decided to be a provider-based health plan to our employees, we were going to be able to better manage population health initiatives beginning with our workforce and engage our physicians,” Clark said.
Companies during the annual open enrollment period, which is this time of year for many organizations, aren’t changing insurance carriers any more or less than in the past ahead of key provisions of the Patient Protection and Affordable Care Act that go in effect next year, said Valerie Bogdan-Powers, vice president of employee benefits services for Cincinnati employee benefits firm HORAN.
“When you’re self-funded, you’re administrative costs are the lowest parts of your costs. If you were moving a carrier, it would typically be because you have some service things that are not being met,” Bogdan-Powers said. “Or their network discounts aren’t giving you the kind of cost savings you’re looking for.”
Employers with fully-insured plans, by contrast, pay a set premium to an insurer and the insurer takes the risk of paying for claims.
The changes are mostly blind to employees, she said. Although, the changes in insurance companies for a self-insured plan could mean differences in the in-network group of providers, and in wellness incentives.
“You’re going to see more and more self-insured coming out in the marketplace,” she said. The benefits of being self-insured are “you’re going to avoid taxes, which ultimately relieves your tax burden. What it allows the employer to do is to really be more engaged in the health plan because they’re taking on the risk.”
Kettering Health operates the hospitals Fort Hamilton, Grandview, Greene, Kettering Medical, Kettering Behavioral, Southview and Sycamore. Premier includes the hospitals Atrium, Good Samaritan, Miami Valley and Upper Valley.
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