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St. Francis Hospital Center and St. Vincent Hospital and Health Care Center have teamed up with two of the state's largest insurance concerns to form a cost-cutting health-care plan, called a preferred provider organization (PPO).
The new program, named the Sagamore Health Network, will be available to Indianapolis-area employers beginning in July. The PPO will offer employers an insurance plan with lower co-payments (a percentage of health-care costs the insureds pay out of pocket) and deductibles, provided employees seek care from St. Vincent, St. Francis or other hospitals that may join the network in the future.
The insurance companies, Fort Wayne-based Lincoln National Life Insurance Co. and Indianapolis-based American United Life Insurance Co., will be able to afford to cover more of the costs of the PPO patients because the network hospitals will implement procedures to reduce those costs. The primary way hospitals will decrease the cost for care of patients under the Sagamore plan is through a utilization review program, says Ken Hoverman, senior benefits manager for Lincoln National.
Under the review program, the type of care rendered to Sagamore patients will be scrutinized by a yet-to-be hired utilization review company. The company will be responsible for following the Sagamore cases to make sure care is being administered in the most economical way.
Hoverman says the utilization review company, which will have a staff of nurses to examine the cases, will be responsible for reviewing each case prior to the patient's admission and for recommending a course of treatment. The nurses will continue to follow the case during the course of the PPO patient's hospital stay and then they would determine a discharge plan. A discharge plan recommended by the review company could involve a patient's early release in exchange for...