The Affordable Care Act puts a new focus on serving more people — and two local health systems are hoping to capitalize on that goal.
Both Sutter Health and Adventist Health are getting into the insurance business with their own health maintenance organizations.
Their approaches and timing are different, but both hope to offer consumers a new choice, while gaining more control over how health-care dollars are spent.
Sutter is further along. The company received its HMO license from the California Department of Managed Health Care on April 5, 2013. The initial sales target for Sutter Health Plus is individuals and small and mid-sized employers in the Sacramento and San Joaquin Valley region.
Marketing began this summer for coverage that started Jan. 1, but enrollment numbers are not available.
The company decided not to participate in Covered California during the first year of the new state health benefit exchange.
Sutter is banking on dramatic changes in the health-care marketplace to make this experience different from its Omni Healthcare HMO, which it sold to Blue Cross at a steep discount in 1999. Now Sutter is a large, integrated company with a broad spectrum of services and annual revenue of more than $9.5 billion. The ultimate goal is to expand the HMO plan across the Sutter network.
Initial enrollment numbers — when they are released later this year — will offer a snapshot on demand and whether pricing of the plan is right.
Meanwhile, Adventist is waiting for approval from state regulators to offer Medicare Advantage plans in three counties: Tuolumne, Mendocino and Kings. The application was filed Oct. 4. Adventist expects approval in early 2014 and plans to kick off coverage in 2015.
Date: Jan 2, 2014