BY MIKE NOLTING
A new option will be available this fall for Medicare-eligible West Virginians through the insurer Peak Health.
The company launched in 2021 offering coverage to 32,000 WVU Medicine employees and families and is now ready to enter the consumer market.
Peak Health is the only provider-owned, provider-sponsored plan option in the state and is owned by WVU Medicine, Marshall Health, Valley Health and Mountain Health.
WVU Medicine President and CEO Albert Wright said open enrollment begins Oct. 15 and runs through Dec. 1 for the plan that provides access to Medicare coverage and additional services not covered by Medicare like dental, pharmacy benefits and even gym memberships.
“We want to simplify things and create a system where we are incentivized to keep people as healthy as possible in the lowest-cost setting,” Wright said Thursday on MetroNews “Talkline.”
Wright said they want long relationships with customers who, over time, can benefit from their strategy of preventive maintenance, health incentives and care. The approach is expected to lower the overall cost of health insurance and improve outcomes.
“Here, if we get good alignment and patients enroll that live here and are going to do business with us permanently, we have the incentive to make those long-term investments like the screenings I mentioned,” Wright said.
Research at the WVU Rockefeller Neuroscience Institute has established that people with dementia develop signs of plaque in the brain up to 15 years before symptoms are displayed. This, in addition to early screening for other serious conditions, will be offered to improve outcomes and reduce long-term costs.
“Screen folks for Alzheimer’s disease earlier in life before this plaque builds up and the start of symptoms,” Wright said. “Those are the types of incentives we’re going to create with Peak Health and through our own financial alignment with our health plan.”
In addition to increasing access to healthcare, the goal is to create a plan that can not just provide care but also things that can help plan participants live fuller, healthier lives.
“That might be making investments in transportation, that might be making investments in safer housing, that might be making investments in food insecurity that today we don’t get to make or we do them at no reimbursement to us,” Wright said.
Making health insurance more understandable and collaborative is addressed by remaining as local as possible to the people who use the plan. Wright said all the major Medicare Advantage option providers are large for-profit companies that maintain call centers staffed with people following a script. Peak, he said, will be responsive and look for solutions.
“If there’s ever a problem for a patient, or in this case, one of our own employees, and this will be true for Peak Medicare Advantage, I can walk downstairs and have it solved in 10 minutes,” Wright said. “That’s very different than when you’re working with an out-of-state insurance company that you’re in constant negotiations with.”
Peak is a Preferred Provider Organization (PPO) meaning some out-of-network providers can be accessed possibly at a higher cost.
