Sutter Health Files for Knox-Keene License

Posted on Sep 14, 2012 in Transformation

First Step Toward Creating a Sutter-Sponsored Health Plan

Sutter Health has filed an application with the California Department of Managed Care (DMHC) for a Knox-Keene License. If the application is approved, the not-for-profit health care network intends to offer a Sutter-operated and sponsored health plan.

“Offering a health plan enables us to partner directly with patients to manage their total health needs, including their ongoing care experience and the total quality and cost of their care,” said Sutter Health President and CEO Pat Fry. “The Knox-Keene License filing represents our first formal step toward delivering the type of high-value health plan products that consumers and employers want and expect. Our proposed Sutter-sponsored health plan will be locally run, and will provide superb service and the great quality we’re known for, along with competitive rates.”
Sutter Health has experience with managing health plans, having operated an HMO during the 1990s. Fry said the timing is right for a Sutter-sponsored plan, noting the growth in Sutter Health’s 5,000-member Sutter Medical Network of doctors, its two-dozen acute care hospitals and robust outpatient and home health network.

“Employers have been asking us to find a way for them to have direct relationships with Sutter Health,” added Peter Anderson, Sutter Health Senior Vice President of Strategy and Business Development. “We’re also seeing the emergence of new care delivery models, such as accountable care organizations (ACOs) and new care approaches from the Centers for Medicare and Medicaid Services (CMS). A Knox-Keene License gives us greater flexibility to participate,” Anderson said.

With DMHC’s approval, Sutter Health will offer a range of HMO products for small and mid-sized employers. If awarded a Knox-Keene License, Sutter Health expects HMO products would first become available in the greater Sacramento and Central Valley regions in early 2014. Sutter Health will also seek the DMHC’s approval to extend its service area to other parts of Sutter’s service area.

Sutter Health will continue to contract with and care for patients covered by other commercial health plans as well as MediCal and Medicare.

Posted by on Sep 14, 2012 in Transformation | Comments Off on Sutter Health Files for Knox-Keene License