Health plan prepares for growth

As health networks serving Reno-Sparks prepare for an increasing population (see November 9, 2015, “Reno’s hospitals growing with community”), a health insurance company based in Reno also is executing its part in a strategic plan designed to provide access to care as the region grows.

Hometown Health, the health insurance division of Renown Health, is operating under Renown’s five-year strategic plan, which took effect July 1. That plan assumes a “pretty significant increase in the demand for care due to the increase in population,” said Vice President Ty Windfeldt, in a phone interview. He added that Renown anticipates growth of 45 to 50 percent.

While some employers moving to northern Nevada will not need health insurance from Hometown Health, they will help spur business expansion for the health plan and other local businesses. Tesla and other large, national employers moving to northern Nevada will come with benefit packages established through Aetna and similar health plans. Hometown Health still plans to serve those companies, however, by providing ancillary services, “where they need that local touch,” Windfeldt said.

As one example of such services, Hometown Health and Renown Medical Group team up to provide occupational health care for covered employees injured on the job. Renown opened a clinic in the Tahoe Reno Industrial Center, especially to meet the needs for occupational health. Thus injured workers do not need to wait and travel back into Reno-Sparks to seek treatment.

Hometown Health will establish an ongoing relationship with all sizes of employers, to identify their needs and then develop or customize programs to meet those needs. As Windfeldt explained, “Most of the larger employers have people on their staff to develop these programs, and we will work with them.”

In preparing to provide health insurance products and services to an expanding community, Hometown Health is planning for a “domino effect.” As Tesla, Switch and other companies come to town, local companies will expand their business and payrolls to meet increasing demand. Hometown Health in turn will expand its capabilities to serve those established companies. Windfeldt foresees “Significant growth within the companies that we serve today, in addition to the new companies that will come into the market.”

Hometown Health already is pursuing initiatives to respond to the increasing demand. Windfeldt noted that some capabilities expand easily. Others are employee dependent, such as the need for more customer service representatives to respond to an enlarged volume of phone calls. To house this growing staff, the health plan is planning to relocate its offices. Individual departments also are carrying out initiatives.

Over the next five years, Windfeldt expects to add 25 employees. The remainder of the extra capacity will come from current computer systems, which are ready for growth now. “We will not need to add capacity to current systems. We can grow for many years to come with the capacity that we have in place,” said Windfeldt.

To process a swelling volume of medical claims, Hometown Health will only need to continue its current processes. Through innovative use of automation, the health plan is able to process 85 percent of its claims automatically, without human intervention. This process is known as auto-adjudication. The health plan can process an average of 160,000 claims per month with a staff of 14 people.

Windfeldt does not expect any significant changes in the benefits that Hometown Health offers. With the implementation of the Affordable Care Act, benefit structures are fairly standardized from state to state. Hometown Health will continue to modify benefits as federal and state regulations require.

Smaller employer groups tend to buy fully insured products, for which they pay a premium to Hometown Health, and the health plan assumes the risk for paying medical claims. Larger employers tend to be self-funded, that is, they pay their claims directly. Thus they need third party administrative services, such as claims processing and customer service. Hometown Health offers all employers a menu of fully insured plans and third party administrative services from which clients can select the insurance plans and services that suit them. Windfeldt and his team project growth in both types of insurance products.

Expanding provider networks to support a population increase estimated at 50,000 is one area of concern, and this is a component of Renown’s strategic plan. Hometown Health is approaching this challenge on a number of fronts, especially by working with Renown Medical Group to ensure that the health plan’s members have timely access to physicians and other providers. Renown has an ongoing effort to increase Renown Medical Group physician panels. “We are confident that we will be able to meet these needs today and in the future,” Windfeldt said.

Hometown Health intends to “continue to stick to our mission,” said Windfeldt, which will enable them to serve their growing membership. The health plan prides itself on its customer focus and its ability to build insurance programs attuned to that focus. Windfeldt explains that, “Really, for us, it is looking at what is needed today and tomorrow, and developing programs in line with our strategic plan.”

Windfeldt pointed out the several advantages that he considers reasons for Hometown Health’s success and ability to meet the challenges of growth. “We are part of Renown Health, community based, a not-for-profit organization and dedicated to serving our community.”

Being not for profit provides the opportunity to reinvest in our community. With this investment, “Our programs will be very capable of meeting the needs as the growth comes in the door,” Windfeldt said.