[copperpress-advertserve-ad-reload zone="3"]
ARCHIVED  June 18, 1999

WINhealth wins broad support

CHEYENNE — When it comes to managed health-care plans, Alaska is said to be the last untouched frontier. If that is true, then Wyoming was next-to-last.

Health maintenance organizations simply weren’t available in this state until just a few years ago, when WINhealth Partners came on the scene.

WINhealth Partners is an unusual managed-care insurance company in that it has the full endorsement of most physicians in the communities it services. In fact, it was the doctors themselves who got the ball rolling. All but a handful of Cheyenne’s 105 physicians contributed $15,000 each to fund the company, and they continue to take an active role in guiding the health-care program by serving on the board and on committees.

Now, Wyoming’s residents, who, until recently, often went out-of-state for health-care services, are keeping miles off their vehicles by visiting their hometown doctors. So far, it’s been a win-win situation for all parties.

In a time when negative press nips at the heels of many HMOs, WINhealth is reveling in its success. The company was formed in 1994 and licensed as an HMO in 1996. In 1998, WINhealth expanded from Cheyenne into Albany, Sweetwater and Carbon counties, and in April of this year, the group was given the OK by the Department of Insurance to expand throughout the state.

“This is a very big deal, and we’re extremely excited,´ said Beth Wasson, executive director of WINhealth. “It’ll give us a chance to target employers who have sites in counties we haven’t been in. That’s quite a few large employers.

“WINhealth was capitalized by the doctors. Therefore, there was a tremendous amount of support for the concept,” Wasson added.

And because of that support, it doesn’t operate like most other HMOs. Patient copay is $10 to $15, much like other plans, but unlike other plans, WINhealth patients are free to see any physician in the network without referrals; out-of-pocket expenses have virtually disappeared.

“We don’t have the gatekeepers. They don’t have to keep a primary-care physician. They’re free to go to specialists,” Wasson said.

If they go outside of the network, however, they can expect to pay more.

Before WINhealth, most Wyoming residents were part of 80/20 insurance plans — they paid 20 percent of charges, and the insurance company paid 80 percent. Depending on services rendered, members could incur hefty out-of-pocket expenses. But, Wasson said, “Wyoming is very independent, and Wyoming people tend to want to control their destiny.”

Which is why the HMO concept, a staple in most states for the last decade, never flew in Wyoming. Not, that is, until Wyoming’s doctors, hospitals and employers came together to work on WINhealth.

Several factors led to the physician support.

“There really is no managed-care element in Wyoming to speak of,” Wasson said. “In Laramie County, the physicians knew something was coming to the marketplace, and if they could be part of developing the rules, they’d be in a better position. By forming their own HMO, they can still control patient care and make decisions and not be liable to an outside party. It has the effect of strengthening the medical community and stabilizing the community as a whole.”

“The greatest frustration physicians have with HMOs is that they are powerless to change the policy or guide policy in the care of their own physicians,´ said Dr. Richard Torkelson, a local physician who was instrumental in starting WINhealth and serves as chairman of the board.

Torkelson believes WINhealth is different in that “It gives a physician a true voice in the care of the patient.” A major key to the success of the Wyoming HMO is that a partnership exists between the employer, patient, physician, hospital and health-care company.

Putting WINhealth into play has required education for patients, employers and physicians.

“It’s a managed-care company, so there are controls in place that manage care,” Torkelson said. “Certain procedures have to be preauthorized, and referrals for out-of-network care need to be preauthorized. It’s not like the old indemnity — order it and don’t worry about it.”

Sue Hickman, human resource manager at American Wyott Corp. in Cheyenne, said her company hired an insurance broker to search for a health care plan comparable to those the company was able to offer its associates in New Rochelle, N.Y., and Dallas. The broker turned up WINhealth.

“It’s been very good for our company. There are always small glitches, but the problems have been minimal,” Hickman said.

When the plan was first offered to the company’s employees in 1997, 95 percent chose to go with the new HMO. Hickman said that in January 1998, enrollment was 100 percent. The company, which makes stainless-steel restaurant equipment, has 235 employees in Wyoming.

All types of businesses have signed on with WINhealth, from those with two employees to 2,000. Wasson said WINhealth is experiencing a monthly growth rate of 5 percent.

“We have close to 200 employers enrolled. At the end of three years, we’re at about 12 percent of the commercial marketplace.” And, she added, the HMO has a 100 percent renewal rate. “We have never lost a group unless it went out of business or moved out of the area of coverage.

“We’re able to take advantage of a market that hasn’t been touched,” Wasson added. It’s really a niche. No other players are in the HMO market [in Wyoming].”

Until WINhealth, many residents seeking medical care went out-of-state. If they planned to go shopping in Denver, for example, they arranged medical visits for that day, too. Now, Wasson said, “They can still go outside of the state if they don’t have the services available, but there are more incentives to stay to get the care that they want.”

WINhealth has contracted with physicians in Denver and Salt Lake City for services that can’t be provided in Wyoming. “We have more contracted physicians in Denver than we do in Wyoming,” Wasson said.

WINhealth is also tied into the National Transplant Network and a national preferred provider organization for those occasions when a Wyoming resident is traveling outside of the coverage area and needs health-care services.

CHEYENNE — When it comes to managed health-care plans, Alaska is said to be the last untouched frontier. If that is true, then Wyoming was next-to-last.

Health maintenance organizations simply weren’t available in this state until just a few years ago, when WINhealth Partners came on the scene.

WINhealth Partners is an unusual managed-care insurance company in that it has the full endorsement of most physicians in the communities it services. In fact, it was the doctors themselves who got the ball rolling. All but a handful of Cheyenne’s 105 physicians contributed $15,000 each to fund the company, and they continue to…

[copperpress-advertserve-ad-reload zone="3"]

Related Content

[copperpress-advertserve-ad-interstitial zone="30"]