The Yale Health Plan lost 40 subscribers in the latest open enrollment period that ended Sunday, but administrators said they are concerned that the number of subscribers is already too high for the University Health Services Center.
More than 32,000 faculty, staff, students and their dependents — representing approximately 75 percent of the total number of enrollees in University-sponsored health care — receive their primary care from UHS. Serving this many patients has helped keep the program from becoming too much of a financial drain, but also has led to long delays for patients, administrators said. A new UHS facility, slated to open in 2009, should alleviate the overcrowding problem, UHS Director Dr. Paul Genecin said.
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Open enrollment periods are the one time each year when faculty, staff and their dependents can switch medical or dental plans. Benefits Manager Julie Kimball said 145 subscribers switched out of the Yale Health Plan, a health maintenance organization, but the plan gained 105 new ones. She said an equal number entered and left the plan last year, but that this year’s drop is not surprising and will not have an effect on the plan.
For the past year, Yale has only offered one alternative medical insurance plan, through Aetna, a health insurance provider. Patients can see any doctor under this plan, but must pay for each office visit as well as for enrollment. The Yale Health Plan only charges for prescription drugs and does not require reimbursement forms for most care. The Aetna plan appeals to some because it has eligible doctors nationwide, not just at UHS, Kimball said. She said most enrollees likely choose the Yale Health Plan because of its lower cost, but also because going to UHS on Hillhouse Avenue can be more convenient.
“It is centralized,” she said. “They do offer a sort of one-stop shopping environment. They have a pharmacy, can take X-rays, have lab work done.”
But the convenience of going to just one place is less significant when waits are so long, some said. Local 35 President Bob Proto said the service and maintenance employees represented by Local 35 are generally pleased with the Yale Health Plan, but concerns — especially with long wait times and staff scheduling problems — have come up.
“You can’t walk in the building now without seeing a line for the pharmacy,” Genecin said. “It’s terrible, but it reflects the huge volume of patients seen.”
Genecin said the current building, which was constructed in 1971, was meant to serve only half the more than 32,000 members the health plan now includes. He said the pharmacy in the building handles three times the volume of prescriptions a neighborhood pharmacy does each day, but in a much smaller physical space.
The new health services center will be located at Canal and Lock Streets, and is set to be completed in late 2009. Genecin said UHS will begin to occupy the building in early 2010.
Though it charges almost nothing to individual employees, the Yale Health Plan has been a financial success for the University, Genecin said. The plan has enrolled at least 75 percent of eligible employees since its inception in 1971, and he said the high rate of subscription yields economies of scale that make the benefits relatively affordable for Yale.
“The success of a staff model health care organization is very dependent on enrollment, because there are a lot of fixed costs,” he said. “Health care is such a big drain of the budget of every big employer. But relative to what health care can cost, there’s a good bit of enthusiasm for being able to enroll most of your employees.”
Until last January, the University offered two alternatives to the Yale Health Plan, but Kimball said adopting one national plan lowered University expenses.