Community Issues That Matter: MSHA affiliate enters health insurance business

9:05 am | October 29, 2012

Earlier this year, Integrated Solutions Health Network (ISHN) formed CrestPoint Health insurance company and AnewCare Collaborative, the region’s first community-based accountable care organization.

CrestPoint Health, based in Johnson City, is a Medicare Advantage organization with a Medicare contract.

ISHN’s primary stakeholder is Mountain States Health Alliance, a not-for-profit health care organization that operates a family of 13 hospitals serving a 29-county, four-state region in Northeast Tennessee, Southwest Virginia, Southeastern Kentucky and Western North Carolina.

ISHN comprises community hospitals, skilled nursing facilities, orthotic/prosthetic providers, durable medical equipment providers, home health agencies, hospice, laboratories, rehabilitation facilities, ambulatory surgery centers and approximately 2,000 physicians, including primary care, specialists and allied health.

How will MSHA’s decision to enter the health insurance market affect its bottom line and the quality of health care provided by MSHA doctors and hospitals, especially at Sycamore Shoals Hospital?

According to MSHA Communications Manager Teresa Hicks, CrestPoint is the region’s first and only insurance company built around the triple aim — better health outcomes, lower cost and higher patient satisfaction.

“CrestPoint promotes healthier living, and it goes hand-in-hand with all the health care services that come with the MSHA accountable care organization (ACO). MSHA got into the health insurance business because it fits in with where health care is headed in the future. We want to stay ahead of the curve rather than behind it.

How does insurance fit in? In order to make an ACO work, the insurance provider has to be willing to accept responsibility too. So far, very few commercial insurance companies in the U.S. have agreed to participate in ACOs, Hicks said.

“The goal of the ACO is not just to treat patients when they’re sick, but to help individuals improve their overall health so they don’t get sick in the first place. This results in fewer hospital visits, lower costs and a better quality of life for every patient.

“If we can help people get healthier by providing services tailored to meet people’s needs, then their insurance costs are less, and that’s good for the entire region,” Hicks said.

Additional information may be found at http://www.crestpointhealth.com.

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