ALBANY — The insurance consultant working with the Dougherty County Commission on proposed changes to county employees’ health plan met some surprisingly vocal opposition to a proposal to make Phoebe Health Partners the exclusive health care provider for participants in the plan.
Commissioners Art Searles, Jack Stone and Muarlean Edwards balked at the exclusivity proposal at a commission work session Monday, though Kirk Rouse of the local Doherty, Duggan and Rouse firm suggested the current health plan covering county, city and Water, Gas & Light Commission employees would have saved $600,000 last year had Phoebe Health Partners provided the discount it is offering under a proposed exclusive contract.
Rouse said, under the proposal, PHP would increase county employee discounts from the current 18 percent to 30 percent. But commissioners quickly voiced their objections.
“I have aproblem with that exclusivity,” Searles said. “Thirty percent doesn’t seem like a lot when you figure exclusivity into it. We need to take a close look at this; I have serious misgivings with this issue.”
Stone used a recent health issue of his own as a means of questioning Rouse about the proposal.
“I had a kidney infection, and I went to Palmyra Park (Palmyra Medical Centers) because I knew I could get in there quick,” Stone said. “They told me with our coverage, I needed to go to Phoebe Putney. I told them I didn’t feel like moving, and I asked the lady if there was any way I could get the same treatment there as I would at Phoebe for around the same cost. She said I could.
“So, are you telling me that, in a situation like that, our insurance would not pay anything at all?”
“Yes,” Rouse replied.
“Well, I don’t like that at all,” Stone said.
Edwards noted that many elderly patients had been with their physicians for a long time and would have trouble finding another to treat them if the physician was not a part of Phoebe Health Partners.
“I know I’d have to change doctors,” she said. When Rouse said that, under the current plan, patients had to pay 20 percent more if they were treated out of the network, Edwards said, “I’d rather pay 40 percent and have my choice than to be told that my insurance was paying zero percent.”
That prompted Stone to ask Rouse about the possibility of leaving coverage the same, with 80 percent payment for in-network coverage and 60 percent for out-of-network.
“You’re saying we could save $600,000 this year, but you’re also saying we have to raise premiums by 15 to 20 percent,” Stone said. “So how much are we really saving? I mean, is Phoebe saying, ‘If I can’t get all of it, I’ll take my marbles and go home’?”
An official with Phoebe Health Partners noted in an e-mail that Phoebe Putney Memorial Hospital is only a part of PHP.
“The current contract and the proposal that has been offered to the city/county/WG&L is from Phoebe Health Partners, a regional physician/hospital organization owned equally by approximately 300 physicians and Phoebe Putney Health System,” the e-mail stated. “The organization (comprises) more than 400 physicians, 11 hospitals, more than 40 ancillary service providers and more than 30 allied health providers.
“... All city/county/WG&L employees (covered lives) will have access to every participating provider through PHP if they continue the contractual arrangement that has been in place since 2000. In addition to access to affordable quality, PHP is now accessed by more than 9,000 covered lives and has an outstanding record of customer service to providers, employer groups, brokers and agents and all covered dependents.”
County Administrator Richard Crowdis told commissioners if they chose not to accept the 30 percent discount rate with PHP and accept an exclusive contract with the organization, premiums would need to go up even more than anticipated to cover the costs of the health plan.
“We’ve talked about increasing the premiums by 15 percent,” Crowdis said. “If we don’t go with the (30 percent) discounts, we’ll have to go back and adjust the premiums to increase by 20 to 25 percent. If you do not take advantage of this opportunity, there will be additional costs.
“It’s rare that I come to you and say we have a way to save $600,000. But you can’t have your cake and eat it, too. We’re talking about just a few people out of network, but if you want to let the tail wag the dog ...”
Commission Chair Jeff Sinyard said the commission needed to remember that most of the funding for the employee health plan is being paid by taxpayers.
“What we have to do is get the best health care at the best possible cost,” he said. “We’re here to negotiate for an entire group, and we have to remember that our taxpayers are paying 75 percent of the costs.
“I don’t care what hospital people use; I want the best health care for our employees at the lowest cost. Bottom line. I guess the biggest question I have is are city employees getting better care and will it cost them less?”
The city, which with WG&L has been a part of the Public Employees Group Health Plan with county employees, initially served notice of its intent to leave the group, but has instead opted to stay in to receive the benefits of a larger number of employees but to utilize its own broker. The city and WG&L have contracted with ShawHankins LLC of Cartersville.
“From what I know, it sounds like they’re getting the same things we’re offering,” Rouse said.
Searles disagreed.
“I’ve talked with constituents who are city employees, and they think they’ve got a better deal,” he said. “I hate to say it like this, but I don’t want to find out the city has outdone us.”
Later at a special called meeting, commissioners voted to accept a 15 percent increase in premium rates and approved a call for staff to “continue persuing” a new contract with Phoebe Health Partners to increase discounts for the right to exclusivity.
“I can go along with that as long as I strongly stress the language of the proposal,” Searles said. “I want them to continue to ‘pursue these matters vigorously,’ but I’m not agreeing to anything that’s been proposed.”