Nevada public employee members' alternate HMO choice: What is it really about?

Members of the Nevada Public Employees’ Benefits Program (PEBP) have been notified of a new alternative insurance plan in addition to the existing Health Maintenance Organization (HMO) plan. The new offering is titled “Alternate HMO Plan Benefit Design — Option 2.”

The plan was negotiated behind closed doors, and approved by the PEBP Board and by the Board of Examiners. PEBP members have until May 31, 2017 to decide whether to enroll in Option 2.

The new plan will have a significant impact on PEBP members’ ability to seek and obtain care in Carson City and the immediate area. Though Option 2 may appear better with lower premiums, it limits a patient’s ability to choose their healthcare provider as well as where they can obtain healthcare services.

The trade-off for a possible lower monthly premium may actually cost much more in the long run with higher out-of-pocket expenses and less access to care.

Those who do not already have a Renown network PCP, who choose Option 2, will be required to establish with a primary care physician in the Renown Health network. PEBP participants in Northern Nevada are expected to be referred to Renown managed labs, hospital services, outpatient care, radiology procedures, etc., unless they have a referral from a Renown network physician.

Option 2 excludes doctors and services in Carson City, Carson Valley, and Dayton from their network that are not associated with the Renown Health network. PEBP members will not be able to obtain care from the family practice and internal med physicians at Carson Tahoe Medical Group, Carson Medical Group; and several independent physicians on staff at Carson Tahoe Health.

Bluntly stated, Option 2 enrollees will be barred from receiving care from the outstanding primary physicians in our community such as; Dr. Jeff Basa, Dr. Mark Brune, Dr. Andrea Weed, Dr. B Bottenberg, Dr. Richard Yamamoto, Dr. Chris Forman, Dr. John Holman, Carson Medical Group Family Practice physicians and more.

Enrollees in Option 2 should expect to be referred to Renown managed specialists only. Without a referral, patients are unable seek specialty care throughout the Carson region. Excluded from providing expert care without a Renown network referral, are specialists such as; Dr. David Baker, Dr. Kevin Halow, Dr. Tim Doyle, Dr. John Kelly, Dr. Mike Edmunds, Dr. Jim Cunningham, and nearly every specialist in the area.

Potentioally excluded by Option 2 are Sierra Surgery, Great Basin Imaging, Carson Tahoe Regional Healthcare, Minden Emergency Care, Dayton Urgent Care, Carson Urgent Care, and the retail clinics in the area’s three Walmart Centers.

Since the outstanding physicians, facilities, and services in Carson are being excluded from Option 2, you have to ask yourself “what is the driver behind this plan”? Let me first state what is not a driver: price to PEBP.

Carson Tahoe Health is one of two service providers under the Hometown Health (HHP) contract with PEBP. The other provider is Renown – which happens to own HHP. Carson Tahoe’s contract assures that PEBP members are not charged any higher fees than those charged by the Renown Health network, HHP’s owner.

Option 2 is also not driven by higher quality. The public is highly encouraged to visit the federal government’s hospital quality site: https://www.medicare.gov/hospitalcompare/search.html. The site provides comparisons for hospital quality, cost and patient satisfaction. Using the site to compare Carson Tahoe’s results against Renown’s tells you everything you need to know.

I strongly encourage PEBP members to fully understand the implications, should they decide to enroll in the Hometown Health HMO Option 2.

— Ed Epperson is CEO and President, Carson Tahoe Health