SUBMITTED BY DR. GREG DUNCAN
This later version of the Q and A on Sutter’s new health plan adds a sentence about Sutter not offering local independent physicians and other independent providers an opportunity to be on the provider panel. This is all public information.
This is the text version, identical to the attachment:
Summary of the new Exclusive Provider Organization (“EPO”) Health Plan recently introduced in Del Norte County by Sutter Health, CalPERS, and Anthem Blue Cross
Q. Who is eligible to be on the plan?
A. So far, Pelican Bay State Prison employees and retirees, and Medicare recipients who need a secondary policy.
Q. Who is on the panel of doctors and other providers available for patients?
A. The EPO provider panel currently includes only doctors and healthcare providers affiliated with Sutter Health. The plan excludes every local physician, nurse practitioner, and physician assistant not affiliated with Sutter Health.
Q. Why is the plan attractive to patients?
A. The new EPO offers subscribers “no out-of-pocket costs for hospitalization” at Sutter Coast Hospital and a zero dollar annual deductible. Even with these added benefits, Anthem reports that premiums for the EPO will be unchanged from the current PERS Choice plan.
Q. What will the new plan mean for patients and local healthcare providers?
A. Currently, the EPO provider list contains only providers who are either employed or contracted with Sutter Coast Hospital, or employed by Sutter Pacific Medical Foundation. Local non-Sutter providers were not informed of the EPO by Sutter, Anthem, or CalPERS.
Q. Who decided to only have Sutter-affiliated healthcare providers on the EPO provider list?
A. According to Anthem Blue Cross, Sutter is determining which physicians will be permitted to participate in the EPO. Sutter did not offer local independent physicians or healthcare providers an opportunity to be on the provider panel.
In summary, Sutter is offering EPO subscribers a health plan with free hospitalization at Sutter’s monopoly hospital (designated as a “sole community provider hospital”) and controlling participation in the provider panel, while mandating patients seek care from a provider list containing only Sutter affiliated providers.
Del Norte County has a healthcare provider shortage. Our county is a federally designated Healthcare Provider Shortage Area and a designated Medically Underserved Area. But Sutter is excluding numerous primary care and specialty providers from its EPO plan. As a result, the provider list currently contains just five specialists, two of whom have moved out of the area.
Sutter also appears to be leveraging its monopoly hospital, a tax exempt public benefit charity, to funnel patients into Sutter’s provider network and drive non-Sutter healthcare providers out of the market. Is this a proper use of a public charity?
