STORY AND PHOTO BY KAREN BOSSICK

St. Luke’s Health System has launched its own wholly owned, not-for-profit subsidiary health plan designed to offer more accessible, affordable health care.

Details of the plan will be made in September after the Your Health Idaho board certifies it.

“Our vision to be the community’s trusted partner in providing exceptional, patient-centered care is central to everything we do. To achieve that vision, we are on a bold and ambitious journey to continually improve quality, access and the affordability of health care for the communities we serve,” said St. Luke’s Health Plan President Matt Wolff. 

 The plan has been in development for a decade—ever since St. Luke’s transitioned from a traditional approach to health care to a value-based approach that involves a budget or fixed cost instead of open-ended reimbursement.

It involves a new recently licensed commercial company and is quite different from anything St. Luke’s has done in the past, Wolff told reporters in a virtual press conference. It could make a difference for a mother who can’t afford baby formula under her current plan, for a small businessman considering laying off employees because health care costs went up and for someone choosing between cancer treatment and putting food on the table, he said.

“The reality is that in terms of affordability, we know health care isn’t where it should be in Idaho,” he said. “Health care premiums and out-of-pocket costs consume roughly one-fifth of the average Idahoan’s income today. It’s simply not affordable by anyone’s standard. We need to lean in towards something different for our community.”

Plan members will be eligible for $0 co-pays for in-network primary care, preventative care and maternity care, said Chief Medical Officer Dr. Jon Schott. There will be no pre-authorization so members have more flexibility.

“Our attempt is to address issues on both sides, both in terms of how patients access and work with insurance companies and with payers,” Schott said. “But also, for providers and removing some of those barriers that we know result in delay of care and sometimes lack of care in general.”

Schott said he and his cohorts believe they have a unique opportunity to build a plan “that's basically how we would want to be treated, how we want our families to be treated, and for our neighbors in our communities. At the end of the day, improving the health for the communities we serve, that's our goal, and the health plan is part of that."

Open enrollment will begin Oct. 15 and run through Dec. 15; coverage will begin Jan. 1, 2023. Employer-sponsored plan offerings will be available for small and large groups. Medicare Advantage plan options will be considered at a later date.

St. Luke’s facilities will continue to accept most other care insurance plans.

To learn more, go to https://stlukeshealthplan.org/.