Idaho exchange contract raises conflict of interest concerns
By Kimberlee Kruesi, Associated Press
BOISE, Idaho (AP) — Idaho has hired St. Luke's Health System to help people choose a health plan on the online insurance exchange, even though the health care giant stands to financially benefit when customers choose certain plans.
Some Your Health Idaho board members raised concerns during their Friday meeting because there is no oversight mechanism that would keep the hospital from steering customers to more lucrative plans. Still, they voted unanimously to approve the $272,000 one-year contract with St. Luke's and the Idaho Primary Care Association after asking Your Health Idaho Executive Director Pat Kelly to find a way to audit the contractors.
"I'm concerned about the possible conflict of interest," said Dr. John Livingston, a surgeon from Boise and a board member. "We need to make sure nobody is steered in a particular direction."
St. Luke's has been in a business partnership with Utah-based insurer SelectHealth, one of the four insurance carriers on the exchange, since 2012. Furthermore, all of the providers on the exchange offer plans tailored around St. Luke's network.
Kelly countered that the concerns are unnecessary because the contractors are required to be impartial and not make recommendations. Counselors are simply supposed to advise customers about the different plans available and tell them how to sign up.
"They are trained to refer customers to a certified agent when asked if a plan is right for that person," Kelly said.
St. Luke's is receiving $18,164 of the $272,000 contract to pay for 50 counselors. The remaining amount will go to the Idaho Primary Care Association.
Compared to the hospital's roughly $2 billion revenue stream, Kelly argued that the contract is immaterial to St. Luke's overall profits.
However, board members remained steadfast in their desire for an auditing check.
"The potential conflict isn't the $18,000, it's the potential to steer thousands into particular plans," said state Sen. Jim Rice, R-Caldwell, also a board member. "That requires some oversight and some auditing to make sure we're not having that problem."
It's unclear why the contract sparked trepidation this year. Your Health Idaho has awarded St. Luke's a so-called "enrollment entity" contract every year since the exchange first launched in 2014.
According to minutes from exchange board meetings in 2016 and 2015, members did not spend any unusual amount of time discussing similar contract recipients and are not recorded as requesting similar oversight for St. Luke's.
"As far as I can recall, I don't think we've had a voluminous number of complaints," Kelly said.
Nearly 106,000 Idahoans enrolled on the state-based exchange this year. The exchange is part of the Affordable Care Act. Idaho was one of a dozen states, as well as the only Republican-dominated state, to launch its own exchange in 2014.
