New independent model may rock the health care boat

An initiative is under way to band together a group of up to 900 independent physicians in southeastern Wisconsin with their own consumer-driven health insurance product, their own pharmacy benefit monitor and a wellness and assessment program for businesses.

If successful, the organization and the insurance product, both to be called Integra Med, could provide a way to help independent physicians remain independent in the face of pressure to join large health care systems.

Integra Med also could provide an alternative for business owners looking for a way to reduce their employee health insurance costs.

The Integra Med initiative is being led by Brookfield gynecologist Dr. Victoria Mondloch, the administrator of the fledgling organization.

“This is a group of independent physicians in the 10 counties of southeastern Wisconsin who are banding together to offer to the corporate world a competitive alternative that keeps the patient-physician relationship intact and offers risk management tools to the employer and employee,” Mondloch said. “We’re taking the independent physician and offering them the ability to stay independent, to practice with the patient and physician jointly making decisions. We’re trying to band together as many of the independent physicians that we can.”

Integra Med would be based in a clinic building in Brookfield, likely along Capitol Drive. The organization is still trying to determine a site for the clinic but plans to open it within six to nine months, Mondloch said. The building would be the headquarters for Integra Med, but only about 30 of its physicians would practice there. Integra Med will not be affiliated with any hospital.

Integra Med will partner with Plymouth, Minn.-based AssureCare, a third-party administrator of employee benefit plans, and its sister company, Kereon HSA Inc., which provides custom-designed, self-funded, consumer-driven health plans. Integra Med will be the exclusive health care provider in southeastern Wisconsin for AssureCare and Kereon.

Northwestern Mutual Life Insurance Co. will market Integra Med to business owners. The consumer-driven Integra Med health insurance product, which will include a health savings account for employees, will offer significant cost savings for businesses, Mondloch said.

“We’re going to go to the corporate client, offer cost savings and offer to tailor insurance benefits the best way for the patients,” Mondloch said. “We can save (a business) $2,000 per employee in the first year. We cut out the insurance company. We cut out the middle man.”

As an added plus, businesses participating in the AssureCare/Kereon plan will be able to invest the money that is put into the health savings accounts with any local bank that they choose.

“It’s a way that a business can improve their relationship with their local bank,” Mondloch said. “We keep the premium in the local community rather than at (an insurance company’s) bank.”

Integra Med’s insurance product also will provide complete cost transparency for its corporate customers, Mondloch said. Business owners will know what they are paying for procedures provided by Integra Med physicians or by other physicians or hospitals outside of Integra Med and will have a chance to compare and contrast what health care providers are charging.

“We’ll be able to show the transparency of costs because we have no vested interest (in a particular hospital),” Mondloch said. “That’s exactly why we do not want a hospital affiliation. We’re going to offer transparency of charge and transparency of cost, which is going to throw the southeastern Wisconsin health care community on its heels.”

Since the Integra Med health insurance product includes an HSA, individual patients will have an incentive to choose the lower cost providers, she said.

Integra Med also will have a pharmacy benefit monitor that will enable patients to purchase drugs at a lower cost because the price savings negotiated by AssureCare will be passed on to the customer, instead of being kept by an insurance company.

The Integra Med business model will be profitable for AssureCare and physicians, Mondloch said, but it won’t generate the windfall profits that other insurance companies and health care providers are able to generate. The willingness to accept less profit allows Integra Med to offer lower pricing, she said.

“As an administrator (of Integra Med), I’m not going to make $50 million,” Mondloch said.

In addition, by banding together a large number of independent physicians, Integra Med allows them to remain competitive and stay independent.

“The independent physician still deserves a place at the table, and it shouldn’t be just businessmen telling physicians how to practice medicine,” Mondloch said.

Employers seeking more information as the Integra Med model takes shape can contact Mondloch at vmondloch@wi.rr.com.

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