St. Luke's Health System faces conflict of interest concerns over its ACA exchange contract

Board members of Idaho's individual health insurance exchange, Your Health Idaho, flagged Boise, Idaho-based St. Luke's Health System's contract to counsel exchange enrollees as a possible conflict of interest, KIVI-TV reports.

Under a recently awarded partial contract, St. Luke's counsels enrolling consumers on Your Health Idaho as they navigate coverage options. Concerned Your Health Idaho board members claim the contract, which includes other insurers, lacks an auditing system to dissuade health systems from guiding consumers toward the most financially beneficial plans. St. Luke's has a joint insurance policy with SelectHealth, a health plan of Intermountain Healthcare in Salt Lake City.

St. Luke's spokesperson Anita Kissée told Becker's Hospital Review via email St. Luke's has "one of the smallest portions of an overall contract with YHI (less than 10 percent of the contract approved last week. [St. Luke's] has $18,000 out of $277,000). There is no auditing system for the entire state, not just St. Luke's."

St. Luke's officials further denied the board members' allegations. The system said its Your Health Idaho counselors sign affidavits pledging impartiality and are "fingerprinted and undergo background checks."

"Of the applicants St. Luke's enrollment counselors have assisted through the entire enrollment process in the last two years, the majority of the applicants selected a plan with Mountain Health CO-OP, the second most selected plan was SelectHealth, then Blue Cross, Bridgespan and Pacific Source," Ms. Kissée said in a prepared statement to KIVI-TV.

In addition, Ms. Kissée told KIVI-TV the health system tracks which plans enrollees choose to ensure counselors are unbiased. However, Pat Kelly, executive director of Your Health Idaho, told board members last week the exchange does not gather that information. 

"We track the information, but YHI does not request it from us. Were that to change, St. Luke's would be fully supportive of the Your Health Idaho oversight function," Ms. Kissée said. 

"We follow the specific rules of Your Health Idaho, just as all other counselors are required. This is something we've done now for several years with no questions or concerns, along with other healthcare organizations as well, and for some reason is being highlighted this year," Ms. Kissée added. "In addition, we do not [necessarily] seek out YHI enrollees. We are included on a list of counselors available, and people reach out directly to St. Luke's. Why they choose to turn to us for guidance is a personal decision, but some reasons could be that we are a trusted health partner in our community, they may have been treated at St. Luke's in the past, or their doctor may be connected to St. Luke's."

For the full report, click here

This article was updated Sept. 20 at 11:27 a.m. to reflect the correct spelling of Ms. Kissée's name and include commentary from St. Luke's.

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