Recent moves by SummaCare — including a new commercial network in Akron and adding Cleveland Clinic into its Medicare Advantage provider network — are strategic steps made by its new president to help the insurer regain its position as the "dominant regional plan in the market."
SummaCare's total membership had gotten a little "stagnant" in recent years, said Bill Epling, who became president of Summa Health's health insurance company in August 2020.
In its Medicare, commercial and individual marketplace offerings, SummaCare currently has about 60,000 subscribers, a total that's been declining.
"Our objective now is to change that trend and start adding some positive growth to those numbers of lives," Epling said.
He wants to get back on track, move toward responsible growth and "re-establish SummaCare as that core Akron-area market leader from a health plan perspective across all of the product lines," he said.
Epling is uniquely familiar with SummaCare's stance in the marketplace, having spent a couple of decades running its longtime competitor. He served as CEO of HomeTown Health Network, a provider-sponsored health plan once based in Stark County, but no longer in existence.
Many health systems have gotten out of the business of provider-sponsored health plans over the years, even in cases of plans that were by all metrics (bottom line, enrollment, reputation, prestige) successful, often because running a health plan isn't necessarily their core competence, said Allan Baumgarten, Minnesota-based health care consultant who studies the Ohio market. SummaCare is "sort of a story of persistence," he said.
For 20 years, Epling competed directly with SummaCare before shifting to a couple of other jobs — as president at WellCare of Ohio Inc. and in the pharmacy benefit management space. He was thinking about semi-retiring when the SummaCare opportunity came up, bringing him full circle.
Epling is thrilled to be back in the space of provider-sponsored health plans, he said.
SummaCare has worked to expand its network in recent years. In 2018, it brought Aultman Health Foundation into its Medicare and commercial networks, and in 2019, it added Lake Health to its Medicare network. In 2017, it announced it would co-brand its existing Medicare products with University Hospitals. Though these and other efforts helped expand the footprint and ability to add covered lives, SummaCare was missing a key component, Epling said.
"Anybody that does business in this industry in Northeast Ohio knows that there are challenges when you have limitations to your network, particularly when most of the other competitors have all systems in their network," he said. "Most of our competitors always included the Cleveland Clinic system and the networks and providers in their offerings. That was a significant network disadvantage for SummaCare."
Two announcements made late summer this year aimed to solve for that missing piece. In August, SummaCare added Cleveland Clinic to its Medicare Advantage provider network. And in September, it announced the launch of a new commercial network that includes Summa, Cleveland Clinic and Akron Children's Hospital.
The notion of must-have providers plays a major role in commercial networks, but insurers may have a little bit more flexibility in the Medicare Advantage or individual plan space when they are not trying to reach out to large or midsize employers, Baumgarten said.
"Whether it's for geographic coverage or whether it's for sort of name brand recognition, it's very hard to be in the employer group insurance market and not have access to basically all the major hospital systems in your geography," he said.
The new network, known as the Preferred Choice Network, will grant members access to the providers of all three health care organizations and both of Akron's Level 1 adult trauma centers.
"That really is, I think, key to leveling the playing field," Epling said. "Bringing to the market a very locally focused, high-quality health plan that now brings access to all of the adult facilities across the market, particularly in the Akron market, with the inclusion of Akron General and that Preferred Choice Network as well."
Epling hopes the moves will help SummaCare attract members and support its ability to competitively price products in the market.
Adding the Clinic to the network is one example of the ways that Epling would like to improve SummaCare's cost structure and contracts with providers, he said, noting that he plans to continue to improve provider contracts in an effort to make costs more competitive. He also sees the individual product line as a growing market going forward, as the current administration expands subsidies and eligibility for exchange products.
As he works through these and other parts of his strategy to return SummaCare to a dominant force in the Akron market, Epling recognizes the challenges ahead.
"The same challenges that are in front of SummaCare are in front of the entire health care delivery and financing systems across the country," Epling said. "But I think we've got an advantage by being again a locally based, integrated organization that is likely more nimble, probably doesn't have as many resources as some of our large competitors, but they're not as nimble and flexible and as integrated as we are, which will allow us to continue to compete in a highly competitive market."
