Reviewing First Choice Health’s network options

In a recent 5 Things newsletter, I highlighted that I understood four plans were applying to enter the public option program known as Cascade Care in Washington State.

One of those plans, according to a source, told me it is using First Choice Health as a provider network. I thought that was interesting. It’s been my experience that First Choice was primarily a PPO network. I thought that might be a tough fit for a Cascade Care program that has comparatively tight reimbursement caps.

Here’s what I wrote about this at the time.

I’m told that at least one of those plans may be using the First Choice provider network, though I can’t verify that myself. That network, which is built on reimbursement equal to 90% of billed charges, would make hitting the provider reimbursement caps in Cascade Care very difficult.

 

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In a review of the First Choice Health site, FCH speaks to the launch of the company as a PPO product.

First Choice Health originated as a Preferred Provider Organization in 1985, serving the area surrounding Seattle, and eventually expanding to serve all of Washington, Oregon, Idaho, and the entire Northwestern United States. Our multi-state PPO Network includes those facilities and healthcare professionals who have agreed to provide quality care to network members at a lower cost.

My opinions were formed initially based, in part, on the FCH’s own website. In the 1980’s and 1990’s, my understanding is that PPO networks were commonly built as billed charge arrangements.

In correspondence with First Choice, a FCH spokesperson wanted to correct my understanding, saying:

First Choice Health’s network is structured with a variety of reimbursement formulas, negotiated on an individual basis with each network provider. Many of the reimbursement formulas use methodologies unrelated to billed charges and, of those that are based on billed charges, First Choice Health has very few contract arrangements at 90% of billed charges.

Moreover, while First Choice still offers a PPO product, FCH has expanded their product offerings to have a more robust set of clinically integrated networks. For example, according to their website, those include:

  • MultiCare Connected Care
  • Eastside Health Network
  • Puget Sound High-Value Network
  • Central Oregon Select

I think these are actually some of the more innovative offerings in the market today – and to be candid, I hadn’t connected the dots of these offerings back to First Choice.

If a plan were using one of these networks or a modified version, that could make for a compelling signal to the market about the intentions of some specific providers to really make a run at trying to serve the Cascade Care market. The University of Washington, Virginia Mason and MultiCare are all making well recognized efforts towards clinical integration and bending the cost curve.

First Choice wouldn’t comment further about its approach when I asked. However, it is certainly the case that First Choice is more than the PPO network it started with – something I now recognize and am happy to clarify.

Whether any network or plan will be able to make it through the Cascade Care regulatory gauntlet remains to be seen.