Albert Wright, president and CEO of WVU Medicine, wants Peak Health to become the iPhone of health insurance providers.
Just like the iPhone replaced countless devices — the landline phone, the camera, the MP3 player, the pedometer — Peak Health aims to replace many of the variables crowding the modern health care landscape with one streamlined system, Wright said.
“Today you’ve got a thousand insurance companies, you’ve got a bunch of hospitals and health care systems, you’ve got pharmacy benefit managers, you’ve got utilization review processes, you’ve got prior authorization review processes,” he said. “We want to take all the health system and payer components and we want to put it in one integrated process.”
WVU Medicine announced plans to launch Peak Health in September 2021, saying the new provider would open as an option for the health care system’s more than 30,000 employees on Jan. 1, 2023.
Having fewer administrative layers between patients and providers will help keep costs down, Wright said.
“We’ve long believed that the only way you truly lower the cost of care or improve outcomes is when you get financial alignment between the people who pay for health care and the people that provide health care,” he said. “We’ve long thought that we needed to take administrative burden out of the care process and start to act as one integrated entity.”
Most of the insurance options currently available in West Virginia are through out-of-state companies, Wright said.
“The vast majority of insurance companies are for-profit, large, multi-billion insurers,” he said. “Their mission is not to improve the health of West Virginians. Their job is to provide financial returns for their investors. We don’t have to do that. Our stakeholders are the people of West Virginia.”
WVU Medicine has said it plans to invest about $15 million in the company for initial startup costs and estimates it will spend about $10 million annually to cover operations costs.
Peak Health will process claims though Epic, the electronic health records system already in use throughout the WVU Medicine Network, Wright said.
“It’s truly interoperable and integrated,” he said.
The company will spend its first year “working the bugs out,” Wright said.
“With our own employees, we can fix it right away,” he said. “I don’t want to go out and try and sell it to the world until we know it’s working.”
Open enrollment for WVU Medicine employees is likely to begin in late October, Wright said.
“We’ll really start to educate them as to why we’re doing this,” he said. “I think that will resonate with them. I think it makes sense to them when I talk about this. I think everybody wants to see if it’s going to work the way we think it’s going to work.”
In 2024, the company plans to begin working with small, self-insured businesses and will then move to begin providing Medicare Advantage plans around the state, Wright said.
“Then a few years down the road we will look to be a Medicare managed care provider in the state,” he said. “And maybe a PEIA (West Virginia Public Employees Insurance Agency) provider in the state if that’s an option for us.”
He is often asked why WVU Medicine, which is already the state’s largest health care system and its largest employer, would want to venture into health insurance, Wright said.
“We are very successful today — we’re a financially viable organization, we’ve got great quality and we’ve been growing. So why would we mess what that?” he said. “When I was a child, in the 1980s, I used to get a Sears catalog every year and I would circle what I wanted for Christmas. Do we get Sears catalogs anymore? If you don’t evolve and figure out how to get better, at some point you become Sears.”
In order to provide the best possible care options to residents, WVU Medicine must pursue goals that “you know are right, but make you uncomfortable because you are stretching the boundaries,” Wright said.
“It would probably be easier and safer for us to not do this, but I think it’s the right thing to do if we’re ever going to be able to take it to the next level of investing in the health of a population that has historically not had great health outcomes,” he said. “I’m confident this is going to be very successful, but it’s not for certain.”
Senior Staff Writer Charles Young can be reached at 304-626-1447 or firstname.lastname@example.org
WVU Medicine’s Albert Wright hopes to make care more affordable, accessible through Peak Health | State Journal News | wvnews.com