Five Questions With: Marc Spooner

"We are excited about the ability of members to receive their care from Lifespan doctors and those who work closely with the Lifespan system at a reduced Tier 1 cost." / COURTESY FAYFOTO

Marc Spooner is president of commercial products at Tufts Health Plan. He is responsible for strategy, sales, marketing and product development, network management and the definition of the commercial products division’s clinical care model. Tufts recently announced an agreement between itself and Lifespan health system. The two have partnered to create Lifespan Premier Choice, a tiered network health plan.

PBN: To what extent do arrangements like that between Lifespan and Tufts represent the future of health care in our region, and in the country?
SPOONER:
Relationships such as the one we recently announced with Lifespan are definitely here to stay. Health care providers and insurers share the same goals, which is to support the health and wellness of their respective patients and members while controlling the cost of that care. Our own experience shows that when we work very closely with providers, the beneficiary of that close working relationship is the patients; they are healthier and their care is more coordinated.

PBN: How important is the feature of the partnership that allows Lifespan Premier Choice members access to the Tufts Health Plan network in both Rhode Island and Massachusetts? Can you describe a scenario in which that would be particularly helpful?
SPOONER:
Access to our broad network is important, and certainly differentiates the product from a limited network offering. But we are excited about the ability of members to receive their care from Lifespan doctors and those who work closely with the Lifespan system at a reduced Tier 1 cost. While members have the choice to go to a different doctor or caregiver, perhaps if they work out of the area, we believe the option of receiving high quality care at Lifespan provides customers with great value.

PBN: Will most members of Lifespan Premier Choice always want to stay in-network – or are the tiers described in the plan close enough in pricing that people will sometimes make the decision to go out of network?
SPOONER:
Lifespan Premier Choice offers individuals incentives for choosing quality providers in Tier 1. The cost savings are in the form of lower deductibles and copays when they choose care that’s provided within the Lifespan Health system, which includes a robust network of more than 1,800 physicians across Rhode Island. The plan structure encourages individuals to choose a Lifespan affiliated physician, while still offering the choice of physicians outside the Lifespan network at higher out-of-pocket costs.

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PBN: What are you hearing from employers about the plan, which initiates July 1, in terms of interest?
SPOONER
: The feedback we’ve received so far is extremely positive. We’ve had the opportunity to conduct briefings with our broker partners, and they see the many benefits Lifespan Premier Choice can bring to their clients. They like the breadth and quality of the Tier 1 network. They also like that maternity care, behavioral health services, and urgent care – regardless of the provider – always default to Tier 1 coverage, the lowest cost to a member. The enthusiasm and support we have heard is very encouraging.

PBN: What kind of numbers are you hoping to see in the first year – what would constitute an outstanding start for you on this?
SPOONER
: We will measure our success based first on our ability to educate the broker and employer community about how the Lifespan Premier Choice product works. And then when an employer purchases the product, by whether our members understand how to access the best care for their family. We’re very confident that the combination of Tufts Health Plan’s service excellence with Lifespan’s clinical excellence – at a cost that is 10-15 percent below a traditional offering – provides great value to the Rhode Island market.

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