Health Link network: Community service or monopoly builder?

By Michaela Gibson Morris
Daily Journal

Health Link has been a bone of contention for state legislators and others who are concerned that the North Mississippi Medical Center system has too tight a grip on health care access in the region.

NMMC officials say the “preferred provider organization” is driven by the needs of area businesses and industries to manage health care costs while giving employees a lot of personal choices.

“People tell us constantly ‘Don’t let anything happen to Health Link,’” said Gerald Wages, NMMC chief operating officer.

What is it?

Although the Health Link stamp is a common sight on health insurance cards around Northeast Mississippi, misconceptions abound.

“It’s not an insurance company,” said Pam Hansen, NMMC vice president who oversees the preferred provider organization.

Health Link brings together a network of physicians and hospitals; employers and health insurance companies set the rules for what services are covered and what share individuals pay.

As with any preferred provider network, in exchange for reduced rates and discounts on health care, employers and insurers provide incentives to their people to use the network, typically by paying a higher proportion of the costs.
Health Link physicians have a set reimbursement schedule that is updated every two years by an independent actuary based on a percentage of Medicare rates, Hansen said. Health Link negotiates reimbursement rates with individual hospitals for the employers and insurers.

Health Link doesn’t handle any of the money for services; it doesn’t send out bills. NMMC owns the separate, for-profit Acclaim, which handles health care claims for self-insured companies, but the companies set the rules for what gets paid.

The Health Link network is overseen by a board of directors of physicians and hospital administrators, including members outside the NMMC system. Gilmore Memorial Hospital chief executive Danny Spreitler of Amory is a recent addition to the board.

Unusual company

Health Link stands out in the ranks of PPOs, particularly because it is not an exclusive network limited to NMMC system hospitals and admitting physicians, said Robie Frizzell, a board member for the American Association of Preferred Provider Organizations. Typically PPOs are run by physicians’ groups or third-party businesses.
“It is unusual,” said Frizzell, who works for the Mississippi Physicians Care Network, which is owned by the Mississippi State Medical Association. “Usually they’re doctor-centered rather than hospital-centered.”

Typically hospital systems have preferred hospital organizations that focus only on affiliated hospitals and the physicians who admit to those hospitals, Frizzell said.

Other PPOs typically charge to cover the costs of doing business, Frizzell said.

Because the NMMC system shoulders the entire cost of Health Link, it doesn’t charge employers, physicians and hospitals for participating in the network.

“We didn’t feel it was appropriate to charge for a network that would bring patients to the hospital,” Wages said.

History

Health Link was created in 1987 at the request of self-insured Northeast Mississippi employers who were looking for help containing health care costs but didn’t have access to the networks insurance companies were creating, Wages said.

“That was the heyday for managed care,” Wages said.

In the mid-1990s, smaller employers, who relied on insurers, were asking for access to Health Link, so the network began contracting with insurance carriers. Now there are six companies, soon to be eight, including Pacific Life and United Healthcare.

“They wouldn’t be in North Mississippi without Health Link,” Wages said.

Who’s in network

Although there are nearly 2,000 health care providers, not including the 47 hospitals in the Health Link network, the door isn’t open to everyone.

Physicians and other health care professionals go through an initial credential process using nationally established criteria, Hansen said. Their credentials are re-evaluated every three years. Additionally, the board evaluates the need for each type of service in a particular location.

The complaints

Detractors say that the NMMC system uses Health Link to play hardball with competitors.
Lee County legislators – Reps. Steve Holland and Jamie Franks and Sen. Alan Nunnelee – each have mentioned Health Link as an area of concern about the NMMC system’s business practices.

Tupelo radiologist Dr. Mike Currie, who had to fight a certificate of need battle against the hospital to install specialized equipment in his independent facility, the Imaging Center, was turned down for membership by Health Link; the network cited lack of need for additional imaging or radiological services in Tupelo.

But the network and hospital system have taken additional steps, creating a more adversarial relationship than Currie believes is necessary among competing businesses.

“It’s not like any other business in this town,” Currie said.

He said he has been told by Health Link-affiliated physicians “they have been strongly discouraged from referring patients to the Imaging Center, regardless of patient wishes.”

Health Link rules specifically allow physicians to refer to out-of-network providers because of patient request or if the service is not provided in network, Hansen said.

“If the patient requests a non-participating provider, the patient will be responsible for an increased portion of the bill,” Hansen said.

Otherwise, network physicians are required to refer to other participating physicians, she said.

Contact Michaela Gibson Morris at 678-1599 or michaela.morris@djournal.com